Provider Demographics
NPI:1043768229
Name:ROEBEN, AMANDA M (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:ROEBEN
Suffix:
Gender:F
Credentials:LCSW
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 1962
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-1962
Mailing Address - Country:US
Mailing Address - Phone:559-578-4058
Mailing Address - Fax:559-242-9182
Practice Address - Street 1:422 N REDINGTON ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4452
Practice Address - Country:US
Practice Address - Phone:559-578-4058
Practice Address - Fax:559-242-9182
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA941781041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical