Healthcare Provider Details

I. General information

NPI: 1376859934
Provider Name (Legal Business Name): CLIFFORD EDWARD ROBERTS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6762 LEXINGTON AVE SUITE A
LOS ANGELES CA
90038-1217
US

IV. Provider business mailing address

1328 2ND ST
SANTA MONICA CA
90401-1122
US

V. Phone/Fax

Practice location:
  • Phone: 323-380-7590
  • Fax: 323-380-7591
Mailing address:
  • Phone: 310-576-1308
  • Fax: 310-576-1027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number73383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: