Individual provider Active NPI

Roberta Jean Tunnell, LCSW

  • Clinical Social Worker
  • Fremont, CA
National Provider Identifier
1235974056
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
76272 Issued in CA
Practice address
39180 Liberty St Ste 205
Fremont, CA 94538-2586
Phone
(510) 451-2000
NPI assigned
Jun 25, 2024
Last updated
Jun 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 76272 CA Primary

Addresses

Primary practice location

39180 Liberty St Ste 205
Fremont, CA 94538-2586

Mailing address

39180 Liberty St Ste 205
Fremont, CA 94538-2586
Phone (510) 451-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240812003127 CA Practitioner - Clinical Social Worker 1951849785 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ocean Psychiatry IncGroup PAC ID 6305277633, 15 clinicians

Practice addresses (Care Compare)

39210 State St
Fremont, CA 94538-1456
Phone (510) 451-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ocean Psychiatry Inc CurrentSince Jul 10, 2024 Accepting new patients
Ocean Psychological Services, Inc. CurrentSince Jun 30, 2024 Accepting new patients

Locations

39180 Liberty St
Ste 205
Fremont, CA 94538
Phone (510) 439-0657

39210 State St
Ste 100
Fremont, CA 94538
Phone (510) 399-7080

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1719273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1235974056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39180 LIBERTY ST STE 205",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945382586",
            "telephone_number": "510-451-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39180 LIBERTY ST STE 205",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945382586",
            "telephone_number": "510-451-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUNNELL",
        "first_name": "ROBERTA",
        "middle_name": "JEAN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-25",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "76272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

Verify at the official NPI Registry.