Provider Demographics
NPI:1295489664
Name:ROBERTS, BREE (AMFT 125791)
Entity type:Individual
Prefix:MS
First Name:BREE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:AMFT 125791
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 KEESHEN DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1917
Mailing Address - Country:US
Mailing Address - Phone:917-359-3429
Mailing Address - Fax:
Practice Address - Street 1:3657 STONER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2838
Practice Address - Country:US
Practice Address - Phone:424-372-7949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125791106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist