Provider Demographics
NPI:1255455333
Name:ROBERTS, JEANETTE S (MFT)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:S
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11545 SUTTON ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-9739
Mailing Address - Country:US
Mailing Address - Phone:707-795-5848
Mailing Address - Fax:707-526-9672
Practice Address - Street 1:1207 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4793
Practice Address - Country:US
Practice Address - Phone:707-571-2215
Practice Address - Fax:707-526-9672
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41433106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist