Provider Demographics
NPI:1396270492
Name:ROBERTO, YVONNE MIRANDA (CAAR)
Entity type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:MIRANDA
Last Name:ROBERTO
Suffix:
Gender:F
Credentials:CAAR
Other - Prefix:MS
Other - First Name:YVONNE
Other - Middle Name:MIRANDA
Other - Last Name:ROBERTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SUDPT
Mailing Address - Street 1:3857 MARTIN WAY E
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5268
Mailing Address - Country:US
Mailing Address - Phone:360-704-7170
Mailing Address - Fax:
Practice Address - Street 1:205 8TH ST
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-2507
Practice Address - Country:US
Practice Address - Phone:360-532-8629
Practice Address - Fax:360-538-9293
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60953558101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor