Provider Demographics
NPI:1487929287
Name:ROBERTS, ELIZABETH (MA, BCBA)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5694 MISSION CENTER RD
Mailing Address - Street 2:SUITE 602, PMB 341
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4355
Mailing Address - Country:US
Mailing Address - Phone:619-985-7344
Mailing Address - Fax:619-220-0215
Practice Address - Street 1:5694 MISSION CENTER RD
Practice Address - Street 2:SUITE 602, PMB 341
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4355
Practice Address - Country:US
Practice Address - Phone:619-985-7344
Practice Address - Fax:619-220-0215
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-10321103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst