Individual provider Active NPI

Roger J Olivarri Jr., PH.D.

  • Psychologist
  • San Antonio, TX
National Provider Identifier
1275821324
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
36843 Issued in TX
Practice address
1350 N Loop 1604 E Ste 106
San Antonio, TX 78232-1425
Phone
(210) 614-4990
Fax
(210) 614-4991
NPI assigned
Jul 11, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X
Psychologist 103T00000X 36843 TX Primary

Addresses

Primary practice location

1350 N Loop 1604 E Ste 106
San Antonio, TX 78232-1425

Mailing address

17915 Bella Luna Way
San Antonio, TX 78257-5012
Phone (210) 391-9688

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20160401000969 TX Practitioner - Clinical Psychologist 7214259621 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Alaniz Counseling and Behavioral Center PCGroup PAC ID 0648596924, 57 clinicians
Nueva Vida Behavioral Health Associates, IncGroup PAC ID 1052540176, 35 clinicians

Practice addresses (Care Compare)

5522 Lone Star Pkwy
Suite 303
San Antonio, TX 78253-6722
Phone (210) 614-4990

9500 Tioga Dr
Suite a
San Antonio, TX 78230-3118
Phone (210) 616-0828

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
36843TXMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Health and Human Services Commission Current Accepting new patients
Health and Human Services Commission CurrentSince Sep 1, 2017 Accepting new patients
Alaniz Counseling and Behavioral Center, P.C. CurrentSince Jan 17, 2020 Accepting new patients
Nueva Vida Behavioral Health Associates,Inc CurrentSince Jul 13, 2023 Accepting new patients
Vcounselors PLLC PastSince May 16, 2022 Accepting new patients

Locations

4110 Guadalupe St
Bldg 637
Austin, TX 78751

9500 Tioga Dr
Ste A
San Antonio, TX 78230
Phone (210) 616-0828

17503 La Cantera Pkwy
Ste 104
San Antonio, TX 78257
Phone (210) 564-9116

6711 S New Braunfels Ave
Ste 100
San Antonio, TX 78223
Phone (210) 531-7805

5522 Lone Star Pkwy
Ste 303
San Antonio, TX 78253
Phone (210) 614-4990

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1310342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1275821324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17915 BELLA LUNA WAY",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782575012",
            "telephone_number": "210-391-9688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 N LOOP 1604 E STE 106",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782321425",
            "telephone_number": "210-614-4990",
            "fax_number": "210-614-4991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVARRI",
        "first_name": "ROGER",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-11",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "36843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.