Provider Demographics
NPI:1740687862
Name:EILEEN ROBERTS PH D INC
Entity type:Organization
Organization Name:EILEEN ROBERTS PH D INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:707-338-9084
Mailing Address - Street 1:1123 S CLOVERDALE BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95425-4402
Mailing Address - Country:US
Mailing Address - Phone:707-338-9084
Mailing Address - Fax:707-433-9084
Practice Address - Street 1:1123 S CLOVERDALE BLVD # 112
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:CA
Practice Address - Zip Code:95425-4402
Practice Address - Country:US
Practice Address - Phone:707-867-6635
Practice Address - Fax:707-433-9084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21296103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty