Provider Demographics
NPI:1033410097
Name:ROYBAL, SHARON MARIE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:MARIE
Last Name:ROYBAL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2727
Mailing Address - Street 2:
Mailing Address - City:CAPISTRANO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624-0727
Mailing Address - Country:US
Mailing Address - Phone:949-632-7355
Mailing Address - Fax:949-248-7304
Practice Address - Street 1:3551 CAMINO MIRA COSTA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3508
Practice Address - Country:US
Practice Address - Phone:949-632-7355
Practice Address - Fax:949-248-7304
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38455106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist