Provider Demographics
NPI:1922294602
Name:ROBOLD, MARY ANGELIQUE
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANGELIQUE
Last Name:ROBOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANGELIQUE
Other - Middle Name:
Other - Last Name:ROBOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2035 E BALL RD
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-5159
Mailing Address - Country:US
Mailing Address - Phone:714-517-6140
Mailing Address - Fax:
Practice Address - Street 1:2035 E BALL RD
Practice Address - Street 2:SUITE 100A
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5159
Practice Address - Country:US
Practice Address - Phone:714-517-6140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker