Provider Demographics
NPI:1962782797
Name:ROBERTS-MEESE, LAUREL ROSE
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:ROSE
Last Name:ROBERTS-MEESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 IRWIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3318
Mailing Address - Country:US
Mailing Address - Phone:415-457-2487
Mailing Address - Fax:
Practice Address - Street 1:910 IRWIN ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3318
Practice Address - Country:US
Practice Address - Phone:415-457-2487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program