Provider Demographics
NPI:1952461378
Name:ROBERTS, JODY Z (MFT)
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:Z
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:JODY
Other - Middle Name:Z
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:919 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2301
Mailing Address - Country:US
Mailing Address - Phone:510-507-4167
Mailing Address - Fax:510-525-7789
Practice Address - Street 1:919 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2301
Practice Address - Country:US
Practice Address - Phone:510-507-4167
Practice Address - Fax:510-525-7789
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37412106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist