Active NPI
Roger Jerome Nunes, ED.D.
- Clinical Psychologist
- Goldsboro, NC
National Provider Identifier
1679631758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1924
- Practice address
- 105 Leon Dr
Goldsboro, NC 27530-9029 - Phone
- (919) 580-9252
- NPI assigned
- Dec 4, 2006
- Last updated
- Sep 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Development & Aging Psychologist | 103TA0700X | 1924 | NC | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 1924 | NC | |
| Clinical Psychologist | 103TC0700X | 1924 | NC | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 1924 | NC | |
| Forensic Psychologist | 103TF0200X | 1924 | NC | |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 1924 | NC |
Addresses
Primary practice location
105 Leon Dr
Goldsboro, NC 27530-9029
Mailing address
105 Leon Dr
Goldsboro, NC 27530-9029
Phone (919) 580-9252
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0324R | Other | NC | LICENSED PSYCHOLOGIST |
| 6000454 | Medicaid | NC |
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 |
|---|---|---|---|
| 1924 | NC | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190851200000",
"number": "1679631758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 LEON DR",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275309029",
"telephone_number": "919-580-9252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 LEON DR",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275309029",
"telephone_number": "919-580-9252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NUNES",
"first_name": "ROGER",
"middle_name": "JEROME",
"name_prefix": "Dr.",
"credential": "ED.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-04",
"last_updated": "2007-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TA0700X",
"taxonomy_group": "",
"desc": "Psychologist, Adult Development & Aging",
"state": "NC",
"license": "1924",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "NC",
"license": "1924",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "1924",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NC",
"license": "1924",
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "NC",
"license": "1924",
"primary": false
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "NC",
"license": "1924",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED PSYCHOLOGIST",
"identifier": "0324R",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6000454",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Goldsboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 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.