Provider Demographics
NPI:1699102004
Name:ROBERTS, DAYLEN CECIL (LCSW)
Entity type:Individual
Prefix:
First Name:DAYLEN
Middle Name:CECIL
Last Name:ROBERTS
Suffix:
Gender:M
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:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:LUCERNE
Mailing Address - State:CA
Mailing Address - Zip Code:95458-0316
Mailing Address - Country:US
Mailing Address - Phone:707-274-5610
Mailing Address - Fax:707-006-1325
Practice Address - Street 1:14715 E. HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:CLEARLAKE OAKS
Practice Address - State:CA
Practice Address - Zip Code:95458
Practice Address - Country:US
Practice Address - Phone:707-989-1800
Practice Address - Fax:707-998-0122
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACSCR1003301852101YA0400X
CACCDS-R1003301852101YA0400X
CAASW872431041C0700X
CA1070441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)