Provider Demographics
NPI:1821549593
Name:ROBERTO, SHIRLEY (CATC111)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:ROBERTO
Suffix:
Gender:F
Credentials:CATC111
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W ISLAY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2830
Mailing Address - Country:US
Mailing Address - Phone:805-448-4471
Mailing Address - Fax:
Practice Address - Street 1:125 W ISLAY ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2830
Practice Address - Country:US
Practice Address - Phone:805-448-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133003111324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility