Healthcare Provider Details

I. General information

NPI: 1467582882
Provider Name (Legal Business Name): EMILY JEMMA ROBERTSON M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 ARLINGTON DR
SAN LEANDRO CA
94578-1132
US

IV. Provider business mailing address

2283 CEDAR ST
BERKELEY CA
94709-1531
US

V. Phone/Fax

Practice location:
  • Phone: 510-481-1222
  • Fax: 510-481-1605
Mailing address:
  • Phone: 510-898-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: