Provider Demographics
NPI:1417154394
Name:ROBERTS, SCOTT JEFFREY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JEFFREY
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 IRONWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-4710
Mailing Address - Country:US
Mailing Address - Phone:925-345-7895
Mailing Address - Fax:
Practice Address - Street 1:1160 IRONWOOD WAY
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-4710
Practice Address - Country:US
Practice Address - Phone:925-457-8950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24419103TA0700X, 103TC0700X, 103TE1100X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports