Active NPI
Kenneth Samine Roberts
- Mental Health Counselor
- Port St. Luice, FL
National Provider Identifier
1154063634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 567 NW Whitney Place, Suite 101
Port St. Luice, FL 34986 - Phone
- (772) 337-8164
- Fax
- (772) 337-8165
- NPI assigned
- Apr 13, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
567 NW Whitney Place, Suite 101
Port St. Luice, FL 34986
Mailing address
567 NW Lake Whitney PL Ste 101
Port St Lucie, FL 34986-1629
Phone (772) 337-8164
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649808000000",
"number": "1154063634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "567 NW LAKE WHITNEY PL STE 101",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349861629",
"telephone_number": "772-337-8164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "567 NW WHITNEY PLACE, SUITE 101",
"city": "PORT ST. LUICE",
"state": "FL",
"postal_code": "34986",
"telephone_number": "772-337-8164",
"fax_number": "772-337-8165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "KENNETH",
"middle_name": "SAMINE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-13",
"last_updated": "2022-04-13",
"certification_date": "2022-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St. Luice, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.