Healthcare Provider Details

I. General information

NPI: 1477481588
Provider Name (Legal Business Name): CARMEN ROBLES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 BEYER BLVD STE B-103
SAN DIEGO CA
92154-3499
US

IV. Provider business mailing address

3065 BEYER BLVD STE B-103
SAN DIEGO CA
92154-3499
US

V. Phone/Fax

Practice location:
  • Phone: 619-723-0340
  • Fax:
Mailing address:
  • Phone: 619-723-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number88024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: