Provider Demographics
NPI:1063896090
Name:ROBERTS, DEBORAH CORINNE (LCSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:CORINNE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 GOLD CENTER DR STE 325
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6177
Mailing Address - Country:US
Mailing Address - Phone:916-364-8395
Mailing Address - Fax:
Practice Address - Street 1:4049 BIG MEADOW WAY
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-7740
Practice Address - Country:US
Practice Address - Phone:916-956-4425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW24999104100000X, 1041C0700X
CA249991041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW24999Medicaid
CALCSW24999Medicare PIN
CALCSW24999Medicare UPIN
CALCSW24999Medicaid
CALCSW24999Medicare Oscar/Certification