Active NPI
Robert E Niemi, LCSW
- Clinical Psychologist
- Chattanooga, TN
National Provider Identifier
1255577375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- P0000000852
- Practice address
- 6110 Shallowford Rd
C O CRC
Chattanooga, TN 37421-1894 - Phone
- (800) 632-6074
- NPI assigned
- Dec 18, 2008
- 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 | P0000000852 | TN | Primary |
Addresses
Primary practice location
6110 Shallowford Rd
C O CRC
Chattanooga, TN 37421-1894
Mailing address
7431 114TH Ave
Suite 104
Largo, FL 33773-5119
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P0000000852 | TN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233705600000",
"number": "1255577375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7431 114TH AVE",
"address_2": "SUITE 104",
"city": "LARGO",
"state": "FL",
"postal_code": "337735119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6110 SHALLOWFORD RD",
"address_2": "C O CRC",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374211894",
"telephone_number": "800-632-6074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIEMI",
"first_name": "ROBERT",
"middle_name": "E",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-12-18",
"last_updated": "2009-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "P0000000852",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chattanooga, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.