Provider Demographics
NPI:1780604124
Name:ROBERTS, VICTORIA S (LCSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:S
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E BRANCH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2849
Mailing Address - Country:US
Mailing Address - Phone:805-474-4761
Mailing Address - Fax:
Practice Address - Street 1:405 E BRANCH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2849
Practice Address - Country:US
Practice Address - Phone:805-474-4761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 12053101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551904OtherMEDICARE UGS
CAFHC70693FMedicaid
CAW1508OtherNHIC
CAW1508OtherNHIC
CA1712131Medicare PIN