Individual provider Active NPI

Debra Roseberry, LISW

  • Clinical Social Worker
  • Des Moines, IA
National Provider Identifier
1043391386
Registry record updated Mar 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
06729 Issued in IA
Practice address
411 Laurel St
Suite 3310
Des Moines, IA 50314-3017
Phone
(515) 643-6290
Fax
(515) 643-6291
NPI assigned
Oct 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 06729 IA Primary

Addresses

Primary practice location

411 Laurel St
Suite 3310
Des Moines, IA 50314-3017

Mailing address

PO Box 1475
Des Moines, IA 50305-1475
Phone (515) 643-6290

Other identifiers 1

IdentifierTypeStateIssuer
1043391386MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395100800000",
    "number": "1043391386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1475",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503051475",
            "telephone_number": "515-643-6290",
            "fax_number": "515-643-6291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 LAUREL ST",
            "address_2": "SUITE 3310",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503143017",
            "telephone_number": "515-643-6290",
            "fax_number": "515-643-6291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSEBERRY",
        "first_name": "DEBRA",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2014-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "06729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043391386",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.