Active NPI
Robert G. Riedel, PH.D.
- Forensic Psychologist
- Lake Worth, FL
National Provider Identifier
1174569487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Forensic Psychologist
- License
- LP0626
- Practice address
- 7830 Belmont Dr
Lake Worth, FL 33467-7828 - Phone
- (320) 491-1376
- NPI assigned
- Jun 22, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP0626 | MN | |
| Forensic Psychologist | 103TF0200X | LP0626 | MN | Primary |
Addresses
Primary practice location
7830 Belmont Dr
Lake Worth, FL 33467-7828
Mailing address
7830 Belmont Dr
Lake Worth, FL 33467-7828
Phone (320) 491-1376
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 063L4RI | Other | MN | BLUE SHIELD OF MINNESOTA |
| 531347300 | Medicaid | MN | |
| 1042326 | Other | MN | PREFERREDONE |
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
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312934400000",
"number": "1174569487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7830 BELMONT DR",
"city": "LAKE WORTH",
"state": "FL",
"postal_code": "334677828",
"telephone_number": "320-491-1376"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7830 BELMONT DR",
"city": "LAKE WORTH",
"state": "FL",
"postal_code": "334677828",
"telephone_number": "320-491-1376"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIEDEL",
"first_name": "ROBERT",
"middle_name": "G.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2011-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP0626",
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "MN",
"license": "LP0626",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF MINNESOTA",
"identifier": "063L4RI",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "531347300",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERREDONE",
"identifier": "1042326",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Worth, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.