Individual provider Active NPI

Lea Miriram Roussos, M.A.

  • Counselor
  • Santa Monica, CA
National Provider Identifier
1043484025
Registry record updated Apr 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
MFC38398 Issued in CA
Practice address
1460 7TH St Ste 206
Santa Monica, CA 90401-2631
Phone
(800) 844-4545
Fax
(800) 844-4545
NPI assigned
Apr 21, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 21, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X MFC38398 CA Primary

Addresses

Primary practice location

1460 7TH St Ste 206
Santa Monica, CA 90401-2631

Mailing address

2118 Wilshire Blvd Ste 299
Santa Monica, CA 90403-5784
Phone (310) 339-6918

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)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
MFC38398CAMDCounselor

NPI Registry JSON

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

{
    "created_epoch": "1208736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208736000000",
    "number": "1043484025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2118 WILSHIRE BLVD STE 299",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904035784",
            "telephone_number": "310-339-6918",
            "fax_number": "800-844-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 7TH ST STE 206",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904012631",
            "telephone_number": "800-844-4545",
            "fax_number": "800-844-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUSSOS",
        "first_name": "LEA",
        "middle_name": "MIRIRAM",
        "name_prefix": "Ms.",
        "credential": "M.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-21",
        "last_updated": "2008-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "CA",
            "license": "MFC38398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2008; 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.