Provider Demographics
NPI:1265638761
Name:ROBERTSON, CHERYL ANNE (RADI)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANNE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RADI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 AUBURN BLVD
Mailing Address - Street 2:ST. 2200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-4167
Mailing Address - Country:US
Mailing Address - Phone:916-473-5764
Mailing Address - Fax:916-473-5766
Practice Address - Street 1:4330 AUBURN BLVD
Practice Address - Street 2:ST. 2200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4167
Practice Address - Country:US
Practice Address - Phone:916-473-5764
Practice Address - Fax:916-473-5766
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor