Provider Demographics
NPI:1598821886
Name:DILL, ROBERTA GOODELL (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:GOODELL
Last Name:DILL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 E LA CARA ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-2743
Mailing Address - Country:US
Mailing Address - Phone:562-716-0486
Mailing Address - Fax:562-597-9431
Practice Address - Street 1:5855 E NAPLES PLZ
Practice Address - Street 2:SUITE 109
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5060
Practice Address - Country:US
Practice Address - Phone:562-716-0486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC15297106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist