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1123 S Cloverdale Blvd # 112 Cloverdale CA 95425-4402 | |
| (707) 867-6635 | |
| (707) 433-9084 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 1123 S Cloverdale Blvd # 112, Cloverdale, California |
| Authorized Official Name and Position | Eileen Roberts (OWNER, PSYCHOLOGIST) |
| Authorized Official Contact | 7073389084 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1123 S Cloverdale Blvd Ste 112 Cloverdale CA 95425-4402 Ph: (707) 338-9084 | 1123 S Cloverdale Blvd # 112 Cloverdale CA 95425-4402 Ph: (707) 867-6635 |
| NPI Number | 1740687862 |
|---|---|
| Provider Enumeration Date | 12/04/2014 |
| Last Update Date | 10/31/2024 |
| Certification Date | 10/31/2024 |
| Medicare PECOS PAC ID | 2466778428 |
|---|---|
| Medicare Enrollment ID | O20150310001291 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740687862 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY21296 (California) | Primary |
| Provider Name | Eileen Denise Roberts |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447309216 PECOS PAC ID: 7719083062 Enrollment ID: I20070502000293 |
| Provider Name | Nina Nehring |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1619500303 PECOS PAC ID: 0244654994 Enrollment ID: I20200803001696 |
Cloverdale Counseling Center, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 216 N Cloverdale Blvd, Cloverdale, CA 95425 Phone: 707-635-9504 | |