Kimberley Robertson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH17233 Issued in FL

Practice address

3292 County Road 220
Middleburg, FL 32068-4357

Phone

(904) 291-5561

Fax

(904) 291-5575

NPI assigned

Aug 21, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2024 through Apr 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Full Circle Counseling Services, LLC

  • Counselor
  • Orange Park, FL
  • NPI 1902253495
  NPD (past)

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

{
    "created_epoch": "1566345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578268800000",
    "number": "1346897683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1726 KINGSLEY AVE STE 2",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734411",
            "telephone_number": "904-278-5644",
            "fax_number": "904-278-5659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3292 COUNTY ROAD 220",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320684357",
            "telephone_number": "904-291-5561",
            "fax_number": "904-291-5575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "KIMBERLEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-21",
        "last_updated": "2020-01-06",
        "certification_date": "2020-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH17233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pedro D Rivera Morillo, M.D.
• Alicia M Rivera, ARNP
• Crystal Riviere, LCSW
• Rizzo Management Services, Inc
• Michael Jessie Visita Roberts, PTA
• Todd Robinson, LMHC
• Lori Ann Roling, RN
• Erin Rollins
• Yvonne Amelia Romero, RN, CDE
• Addison McKendree Rosborough, FNP-BC

• Mental Health Counselor in Middleburg, FL
• Providers in Middleburg, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; 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.

Verify at the official NPI Registry.