Provider Demographics
NPI:1043398530
Name:ROBERSON, MARVIN (LCSW)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:ROBERSON
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 1:1000 BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4899
Mailing Address - Country:US
Mailing Address - Phone:619-401-5509
Mailing Address - Fax:619-401-5452
Practice Address - Street 1:1000 BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4899
Practice Address - Country:US
Practice Address - Phone:619-401-5509
Practice Address - Fax:619-401-5452
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1272101041C0700X
171M00000X
CAASW1256461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator