Provider Demographics
NPI:1023473485
Name:LINDA ROBERTSON, MARRIAGE & FAMILY THERAPIST, INC.
Entity type:Organization
Organization Name:LINDA ROBERTSON, MARRIAGE & FAMILY THERAPIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:949-697-9153
Mailing Address - Street 1:22 LA CERRA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3809
Mailing Address - Country:US
Mailing Address - Phone:949-697-9153
Mailing Address - Fax:
Practice Address - Street 1:22 LA CERRA DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3809
Practice Address - Country:US
Practice Address - Phone:949-697-9153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44929106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty