Provider Demographics
NPI:1326480906
Name:ROBERTS, SALLY M (MFT TRAINEE)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:M
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MFT TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 TALBOT AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2333
Mailing Address - Country:US
Mailing Address - Phone:510-847-0572
Mailing Address - Fax:
Practice Address - Street 1:1143 TALBOT AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2333
Practice Address - Country:US
Practice Address - Phone:510-847-0572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program