Provider Demographics
NPI:1376859934
Name:ROBERTS, CLIFFORD EDWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:EDWARD
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1122
Mailing Address - Country:US
Mailing Address - Phone:310-576-1308
Mailing Address - Fax:310-576-1027
Practice Address - Street 1:6762 LEXINGTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-1217
Practice Address - Country:US
Practice Address - Phone:323-380-7590
Practice Address - Fax:323-380-7591
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA733831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical