Provider Demographics
NPI:1093514671
Name:CARLI-ROBERTSON, SAMANTHA (PPS)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:CARLI-ROBERTSON
Suffix:
Gender:
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 ANTONE WAY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7550
Mailing Address - Country:US
Mailing Address - Phone:925-833-4200
Mailing Address - Fax:
Practice Address - Street 1:3300 ANTONE WAY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-7550
Practice Address - Country:US
Practice Address - Phone:925-833-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200059985101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool