Individual provider Active NPI

Rita Louise Kirk, PSY.D.

  • Clinical Psychologist
  • Roseville, CA
National Provider Identifier
1679586127
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY 20770 Issued in CA
Practice address
775 Sunrise Ave
Ste.110
Roseville, CA 95661-4523
Phone
(916) 801-6685
Fax
(916) 773-8097
NPI assigned
Aug 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY 20770 CA Primary

Addresses

Primary practice location

775 Sunrise Ave
Ste.110
Roseville, CA 95661-4523

Mailing address

775 Sunrise Ave
Ste.110
Roseville, CA 95661-4523
Phone (916) 801-6685

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY 20770CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Fall Creek Counceling Associates Past Accepting new patients
Debra Moore, PH.D. Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679586127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "775 SUNRISE AVE",
            "address_2": "STE.110",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614523",
            "telephone_number": "916-801-6685",
            "fax_number": "916-773-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 SUNRISE AVE",
            "address_2": "STE.110",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614523",
            "telephone_number": "916-801-6685",
            "fax_number": "916-773-8097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRK",
        "first_name": "RITA",
        "middle_name": "LOUISE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 20770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.