Provider Demographics
NPI:1295464840
Name:ROBERTSON, SHERMAINE (BEHAVIORAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:SHERMAINE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:BEHAVIORAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 CORBIN AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2914
Mailing Address - Country:US
Mailing Address - Phone:818-660-8758
Mailing Address - Fax:833-728-0328
Practice Address - Street 1:5530 CORBIN AVE
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2914
Practice Address - Country:US
Practice Address - Phone:818-660-8758
Practice Address - Fax:833-728-0328
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11939817103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0Medicaid