Active NPI
Scott Jeffrey Roberts, PSYD
- Clinical Neuropsychologist
- Concord, CA
National Provider Identifier
1417154394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 24419
- Practice address
- 1160 Ironwood Way
Concord, CA 94521-4710 - Phone
- (925) 457-8950
- NPI assigned
- Jul 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Development & Aging Psychologist | 103TA0700X | 24419 | CA | |
| Clinical Psychologist | 103TC0700X | 24419 | CA | |
| Exercise & Sports Psychologist | 103TE1100X | 24419 | CA | |
| Clinical Neuropsychologist | 103G00000X | 24419 | CA | Primary |
Addresses
Primary practice location
1160 Ironwood Way
Concord, CA 94521-4710
Mailing address
1160 Ironwood Way
Concord, CA 94521-4710
Phone (925) 345-7895
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 |
|---|---|---|---|
| 24419 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676246400000",
"number": "1417154394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1160 IRONWOOD WAY",
"city": "CONCORD",
"state": "CA",
"postal_code": "945214710",
"telephone_number": "925-345-7895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1160 IRONWOOD WAY",
"city": "CONCORD",
"state": "CA",
"postal_code": "945214710",
"telephone_number": "925-457-8950"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "SCOTT",
"middle_name": "JEFFREY",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-02",
"last_updated": "2023-02-13",
"certification_date": "2023-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TA0700X",
"taxonomy_group": "",
"desc": "Psychologist, Adult Development & Aging",
"state": "CA",
"license": "24419",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "24419",
"primary": false
},
{
"code": "103TE1100X",
"taxonomy_group": "",
"desc": "Psychologist, Exercise & Sports",
"state": "CA",
"license": "24419",
"primary": false
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "CA",
"license": "24419",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.