Provider Demographics
NPI:1760425359
Name:SEIFERT, PH.D., ROBERTA TERRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:TERRY
Last Name:SEIFERT, PH.D.
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:ROBERTA
Other - Middle Name:SEIFERT
Other - Last Name:YABLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:817 D ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2813
Mailing Address - Country:US
Mailing Address - Phone:415-456-1777
Mailing Address - Fax:415-451-7902
Practice Address - Street 1:817 D ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2813
Practice Address - Country:US
Practice Address - Phone:415-456-1777
Practice Address - Fax:415-451-7902
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5133103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00PL51330Medicare ID - Type Unspecified