Active NPI
Deborah Rozelle, PSY.D.
- Clinical Psychologist
- Providence, RI
National Provider Identifier
1154429454
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS01896
- Practice address
- 205 Waterman St Ste 105
Providence, RI 02906-4313 - Phone
- (781) 862-4800
- Fax
- (401) 252-4203
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 3728 | MA | |
| Clinical Psychologist | 103TC0700X | 7589 | MA | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 7589 | MA | |
| Clinical Psychologist | 103TC0700X | PS01896 | RI | Primary |
Addresses
Primary practice location
205 Waterman St Ste 105
Providence, RI 02906-4313
Mailing address
205 Waterman St Ste 105
Providence, RI 02906-4313
Phone (781) 862-4800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154429454-7698 | Other | RI | BCBS OF RI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2022 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7589 | MA | MD | Clinical Psychologist |
| 3728 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629417600000",
"number": "1154429454",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 WATERMAN ST STE 105",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029064313",
"telephone_number": "781-862-4800",
"fax_number": "401-252-4203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 WATERMAN ST STE 105",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029064313",
"telephone_number": "781-862-4800",
"fax_number": "401-252-4203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROZELLE",
"first_name": "DEBORAH",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2021-08-20",
"certification_date": "2021-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "3728",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "7589",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MA",
"license": "7589",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "RI",
"license": "PS01896",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF RI",
"identifier": "1154429454-7698",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.