Provider Demographics
NPI:1013643584
Name:ROBERTA TARGINO, PLLC
Entity Type:Organization
Organization Name:ROBERTA TARGINO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARGINO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-TX, LMHC-FL
Authorized Official - Phone:904-629-3776
Mailing Address - Street 1:4209 GANDARA BND
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6781
Mailing Address - Country:US
Mailing Address - Phone:904-629-3776
Mailing Address - Fax:
Practice Address - Street 1:4209 GANDARA BND
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6781
Practice Address - Country:US
Practice Address - Phone:737-637-1360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health