Provider Demographics
NPI:1528206083
Name:THOMAS, ROBERTA L (MFT)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 E ROWLAND ST STE 112
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3230
Mailing Address - Country:US
Mailing Address - Phone:626-598-3379
Mailing Address - Fax:
Practice Address - Street 1:527 E ROWLAND ST STE 112
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3230
Practice Address - Country:US
Practice Address - Phone:626-598-3379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28549106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7544Medicaid