Provider Demographics
NPI:1528118577
Name:POWELL, ROBERTA CELEST (LCSW, PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:CELEST
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 LAS POSITAS RD
Mailing Address - Street 2:MEDICINE A
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-9627
Mailing Address - Country:US
Mailing Address - Phone:925-243-2723
Mailing Address - Fax:925-243-2708
Practice Address - Street 1:3000 LAS POSITAS RD
Practice Address - Street 2:MEDICINE A
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-9627
Practice Address - Country:US
Practice Address - Phone:925-243-2723
Practice Address - Fax:925-243-2708
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 9544103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral