Provider Demographics
NPI:1073995189
Name:ROBERTS, TONY (MA PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MA PSYCHOLOGY
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA PSYCHOLOGY
Mailing Address - Street 1:1717 CALIFORNIA DR APT 45
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6688
Mailing Address - Country:US
Mailing Address - Phone:707-450-7358
Mailing Address - Fax:
Practice Address - Street 1:1717 CALIFORNIA DR APT 45
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6688
Practice Address - Country:US
Practice Address - Phone:707-450-7358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)