Active NPI
Brooke Devine
- School Psychologist
- Roanoke, VA
National Provider Identifier
1316418478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 0813000160
- Practice address
- 40 Douglas Ave NW
Roanoke, VA 24012-4611 - Phone
- (540) 853-2468
- NPI assigned
- Dec 16, 2018
- Last updated
- Dec 16, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 0813000160 | VA | Primary |
Addresses
Primary practice location
40 Douglas Ave NW
Roanoke, VA 24012-4611
Mailing address
40 Douglas Ave NW
Roanoke, VA 24012-4611
Phone (540) 853-2468
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0813000160 | Medicaid | VA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0813000160 | VA | MD | School Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roanoke City Public Schools | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Local Education Agency (LEA)
- Roanoke, VA
- NPI 1154348985
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544918400000",
"number": "1316418478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 DOUGLAS AVE NW",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240124611",
"telephone_number": "540-853-2468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 DOUGLAS AVE NW",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240124611",
"telephone_number": "540-853-2468"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEVINE",
"first_name": "BROOKE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-16",
"last_updated": "2018-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "VA",
"license": "0813000160",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0813000160",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 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.