Provider Demographics
NPI:1821460577
Name:ROBERTS, ERIN LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:LYNN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:LYNN
Other - Last Name:KILLEBREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4104 EUCALYPTUS LN
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-3851
Mailing Address - Country:US
Mailing Address - Phone:818-554-6918
Mailing Address - Fax:
Practice Address - Street 1:2180 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4513
Practice Address - Country:US
Practice Address - Phone:805-781-4850
Practice Address - Fax:805-781-4866
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38139167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician