Provider Demographics
NPI:1083407969
Name:ROBERTS, STEPHANIE (AMFT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 JADE CT APT 12
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-2361
Mailing Address - Country:US
Mailing Address - Phone:925-337-6137
Mailing Address - Fax:
Practice Address - Street 1:1300 VALLEY HOUSE DR STE 100
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-4931
Practice Address - Country:US
Practice Address - Phone:707-794-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145691106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist