Provider Demographics
NPI:1669522462
Name:PALOMBI, ROBERTA MARION (MFT)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:MARION
Last Name:PALOMBI
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 1:34859 FREDRICK ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-0000
Mailing Address - Country:US
Mailing Address - Phone:951-678-7772
Mailing Address - Fax:951-678-4999
Practice Address - Street 1:34859 FREDRICK ST
Practice Address - Street 2:SUITE 111
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-0000
Practice Address - Country:US
Practice Address - Phone:951-678-7772
Practice Address - Fax:951-678-4999
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 34553106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist