Active NPI
Robin S Keller, PHD
- Psychologist
- Berkeley, CA
National Provider Identifier
1346344645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY12960
- Practice address
- 2484 Shattuck Ave
Ste 210
Berkeley, CA 94704 - Phone
- (510) 704-7475
- Fax
- (510) 704-7494
- NPI assigned
- Sep 8, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY12960 | CA | Primary |
Addresses
Primary practice location
2484 Shattuck Ave
Ste 210
Berkeley, CA 94704
Mailing address
2484 Shattuck Ave
Ste 210
Berkeley, CA 94704
Phone (510) 704-7475
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6321 | Other | CA | MEDICAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2023 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY12960 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1346344645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2484 SHATTUCK AVE",
"address_2": "STE 210",
"city": "BERKELEY",
"state": "CA",
"postal_code": "94704",
"telephone_number": "510-704-7475",
"fax_number": "510-704-7494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2484 SHATTUCK AVE",
"address_2": "STE 210",
"city": "BERKELEY",
"state": "CA",
"postal_code": "94704",
"telephone_number": "510-704-7475",
"fax_number": "510-704-7494"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "ROBIN",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY12960",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL",
"identifier": "6321",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.