Provider Demographics
NPI:1740577618
Name:ROBERTO, LORI KLETT (PHD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:KLETT
Last Name:ROBERTO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 UNIVERSITY AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6744
Mailing Address - Country:US
Mailing Address - Phone:916-206-1741
Mailing Address - Fax:
Practice Address - Street 1:601 UNIVERSITY AVE STE 222
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6744
Practice Address - Country:US
Practice Address - Phone:916-206-1741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20491103TH0004X
CA20491103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth