Roberta Latefa Mineo, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

32488 Issued in CA

Practice address

3291 Sullivan Rd
Sebastopol, CA 95472-9388

Phone

(707) 953-1139

NPI assigned

Oct 25, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618185600000",
    "number": "1013469048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 329",
            "city": "GRATON",
            "state": "CA",
            "postal_code": "954440329",
            "telephone_number": "707-953-1139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3291 SULLIVAN RD",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954729388",
            "telephone_number": "707-953-1139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINEO",
        "first_name": "ROBERTA",
        "middle_name": "LATEFA",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-25",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "32488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Constance Iha Miles, LM CPM RN
• Katherine Ann Miller, FNP-C
• Marlys Miller, RRT
• Michelle Anne Miller, LCSW
• Trevor Ross Miller, D.C.
• Norman Jay Mintz, O.D.
• Asieh Moghaddam
• Conor Michael Moldowan, RPH
• Audrey Molony-Benjamin, CMT
• Michelle Montalbano

• Clinical Psychologist in Sebastopol, CA
• Providers in Sebastopol, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.