Provider Demographics
NPI:1811050206
Name:HUBERMAN, ROBERTA (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:
Last Name:HUBERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FIFER AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1134
Mailing Address - Country:US
Mailing Address - Phone:415-945-0669
Mailing Address - Fax:
Practice Address - Street 1:2 FIFER AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1134
Practice Address - Country:US
Practice Address - Phone:415-945-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG209062084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41101Medicare UPIN