Provider Demographics
NPI:1215060702
Name:ROBERTS, LAVERNE KAY (CADC-1, BS)
Entity type:Individual
Prefix:MS
First Name:LAVERNE
Middle Name:KAY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CADC-1, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 LENZEN AVE RM 1900
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2737
Mailing Address - Country:US
Mailing Address - Phone:408-792-5507
Mailing Address - Fax:
Practice Address - Street 1:976 LENZEN AVE RM 1900
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2737
Practice Address - Country:US
Practice Address - Phone:408-792-5507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)