Provider Demographics
NPI:1073552899
Name:ROBERTS, MARLYNE DIANE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARLYNE
Middle Name:DIANE
Last Name:ROBERTS
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 52573
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92517-3573
Mailing Address - Country:US
Mailing Address - Phone:951-924-3494
Mailing Address - Fax:951-488-1156
Practice Address - Street 1:710 RIMPAU AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-5724
Practice Address - Country:US
Practice Address - Phone:951-924-3494
Practice Address - Fax:951-488-1156
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist