Healthcare Provider Details

I. General information

NPI: 1457456030
Provider Name (Legal Business Name): ELISA L ROBERTSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 N MAIN ST
ALTURAS CA
96101-3496
US

IV. Provider business mailing address

441 N MAIN ST
ALTURAS CA
96101-3496
US

V. Phone/Fax

Practice location:
  • Phone: 530-233-6312
  • Fax: 530-233-6339
Mailing address:
  • Phone: 530-233-6312
  • Fax: 530-233-6339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 25064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: