Provider Demographics
NPI:1437850476
Name:ROBERTS, DANIEL LELAND (RADT-1)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LELAND
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:RADT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 W AVENUE J STE 206
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2954
Mailing Address - Country:US
Mailing Address - Phone:661-802-7167
Mailing Address - Fax:
Practice Address - Street 1:1331 W AVENUE J STE 206
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2954
Practice Address - Country:US
Practice Address - Phone:661-802-7167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)