Active NPI
Jeanine Ann Roose, PH.D.
- Clinical Psychologist
- Valley Village, CA
National Provider Identifier
1306311006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY5489
- Practice address
- 4941 Wilkinson Ave. Ste. a
Valley Village, CA 91607 - Phone
- (818) 990-6150
- Fax
- (818) 763-7030
- NPI assigned
- Oct 9, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 | PSY5489 | CA | Primary |
Addresses
Primary practice location
4941 Wilkinson Ave. Ste. a
Valley Village, CA 91607
Mailing address
4941 Wilkinson Ave. Ste. a
Valley Village, CA 91607
Phone (818) 990-6150
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY5489 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539043200000",
"number": "1306311006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4941 WILKINSON AVE. STE. A",
"city": "VALLEY VILLAGE",
"state": "CA",
"postal_code": "91607",
"telephone_number": "818-990-6150",
"fax_number": "818-763-7030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4941 WILKINSON AVE. STE. A",
"city": "VALLEY VILLAGE",
"state": "CA",
"postal_code": "91607",
"telephone_number": "818-990-6150",
"fax_number": "818-763-7030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROOSE",
"first_name": "JEANINE",
"middle_name": "ANN",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-09",
"last_updated": "2018-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY5489",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valley Village, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.