Active NPI
Sean Robertson, PSYD
- Clinical Psychologist
- Newberg, OR
National Provider Identifier
1164996542
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3737
- Practice address
- 1010 W Charles St
Newberg, OR 97132-2530 - Phone
- (971) 385-1834
- NPI assigned
- Jan 18, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3737 | OR | Primary |
Addresses
Primary practice location
1010 W Charles St
Newberg, OR 97132-2530
Mailing address
PO Box 504
Newberg, OR 97132-0504
Phone (971) 385-1834
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 20, 2023 through Oct 20, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3737 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699920000000",
"number": "1164996542",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 504",
"city": "NEWBERG",
"state": "OR",
"postal_code": "971320504",
"telephone_number": "971-385-1834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 W CHARLES ST",
"city": "NEWBERG",
"state": "OR",
"postal_code": "971322530",
"telephone_number": "971-385-1834"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "SEAN",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-01-18",
"last_updated": "2023-11-14",
"certification_date": "2023-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "3737",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newberg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; 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.