Roberta Terry Seifert, PH.D., PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY5133 Issued in CA

Practice address

817 D St
San Rafael, CA 94901-2813

Phone

(415) 456-1777

Fax

(415) 451-7902

NPI assigned

Jun 13, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Roberta Seifert Yablon Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2015 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318636800000",
    "number": "1760425359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 D ST",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012813",
            "telephone_number": "415-456-1777",
            "fax_number": "415-451-7902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 D ST",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012813",
            "telephone_number": "415-456-1777",
            "fax_number": "415-451-7902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEIFERT, PH.D.",
        "first_name": "ROBERTA",
        "middle_name": "TERRY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-13",
        "last_updated": "2011-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY5133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROBERTA",
            "last_name": "YABLON",
            "middle_name": "SEIFERT",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Psychologist in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.