Active NPI
Vanessa Handsel Roddenberry, PH.D.
- Clinical Psychologist
- Raleigh, NC
National Provider Identifier
1780029488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4628
- Practice address
- 8303 Six Forks Rd Ste 207
Raleigh, NC 27615-3094 - Phone
- (919) 245-7791
- Fax
- (919) 867-2786
- NPI assigned
- May 8, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | |||
| Cognitive & Behavioral Psychologist | 103TB0200X | |||
| Clinical Psychologist | 103TC0700X | 4628 | NC | Primary |
Addresses
Primary practice location
8303 Six Forks Rd Ste 207
Raleigh, NC 27615-3094
Mailing address
8303 Six Forks Rd Ste 207
Raleigh, NC 27615-3094
Phone (919) 245-7791
Medicare participation
Medicare enrollment files- 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
- Opted out of Medicare
- Yes, effective Jun 22, 2018 through Jun 22, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Breyta Psychological Services, P.a. | Psychologist | Current | Accepting new patients |
Locations
8303 Six Forks Rd
Ste 207
Raleigh, NC 27615
Phone (919) 245-7791
Organizations & group practices 1
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.
-
- Psychologist
- Raleigh, NC
- NPI 1871076406
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611273600000",
"number": "1780029488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8303 SIX FORKS RD STE 207",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276153094",
"telephone_number": "919-245-7791",
"fax_number": "919-867-2786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8303 SIX FORKS RD STE 207",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276153094",
"telephone_number": "919-245-7791",
"fax_number": "919-867-2786"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODDENBERRY",
"first_name": "VANESSA",
"middle_name": "HANDSEL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-08",
"last_updated": "2021-01-22",
"certification_date": "2021-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "4628",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; 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.