Provider Demographics
NPI:1093061244
Name:ROBERTS, MARTHA LORRAINE (MFT/INTERN)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LORRAINE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MFT/INTERN
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:LORRAINE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT/INTERN
Mailing Address - Street 1:4200 BAY ST
Mailing Address - Street 2:APT 247
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-4235
Mailing Address - Country:US
Mailing Address - Phone:909-503-6733
Mailing Address - Fax:
Practice Address - Street 1:39155 LIBERTY ST
Practice Address - Street 2:STE E500
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1513
Practice Address - Country:US
Practice Address - Phone:510-574-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program