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General NPI Number Information
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NPI Number | 1740687862
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Entity Type | Organization
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Legal Business Name | EILEEN ROBERTS PH D INC
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Dates
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Enumeration Date | 12/04/2014
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1123 S CLOVERDALE BLVD # 112
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City | CLOVERDALE
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State | CA
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Zip | 95425-4402
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Country | US
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Telephone | 707-867-6635
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Fax | 707-433-9084
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Provider Business Mailing Address
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Address Line | 1123 S CLOVERDALE BLVD STE 112
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City | CLOVERDALE
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State | CA
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Zip | 95425-4402
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Country | US
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Telephone | 707-338-9084
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Fax | 707-433-9084
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Authorized Official
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Title or Position | OWNER, PSYCHOLOGIST
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Name | EILEEN ROBERTS
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Credential | PH.D.
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Telephone | 707-338-9084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY21296
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License Number State | CA
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