Provider Demographics
NPI:1942315932
Name:ROBERTS, ROBIN J (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:J
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 GAYLEY AVE
Mailing Address - Street 2:221
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3424
Mailing Address - Country:US
Mailing Address - Phone:310-209-6292
Mailing Address - Fax:323-931-6888
Practice Address - Street 1:1015 GAYLEY AVE
Practice Address - Street 2:221
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3424
Practice Address - Country:US
Practice Address - Phone:310-209-6292
Practice Address - Fax:323-931-6888
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS16633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health