Provider Demographics
NPI:1144410440
Name:ROBERTS, NAPHTALI VAIL (MFT)
Entity type:Individual
Prefix:
First Name:NAPHTALI
Middle Name:VAIL
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MFT
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 495
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91503-0495
Mailing Address - Country:US
Mailing Address - Phone:818-669-4850
Mailing Address - Fax:
Practice Address - Street 1:1223 VERDUGO BLVD
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3139
Practice Address - Country:US
Practice Address - Phone:818-669-4850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 57905106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist