Individual provider Active NPI

Roberta Burkett, LEP

  • Counseling Psychologist
  • San Diego, CA
National Provider Identifier
1780087791
Registry record updated Oct 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
LEP3395 Issued in CA
Practice address
2650 Camino del Rio N Ste 211
San Diego, CA 92108-1632
Phone
(619) 754-0328
Fax
(619) 303-8152
NPI assigned
Oct 3, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 3, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X LEP3395 CA Primary

Addresses

Primary practice location

2650 Camino del Rio N Ste 211
San Diego, CA 92108-1632

Mailing address

9205 Brookside Cir
Spring Valley, CA 91977-1102
Phone (619) 754-0328

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

LicenseStateTypeSpecialty
LEP3395CAMDCounseling Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1412294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412294400000",
    "number": "1780087791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9205 BROOKSIDE CIR",
            "city": "SPRING VALLEY",
            "state": "CA",
            "postal_code": "919771102",
            "telephone_number": "619-754-0328",
            "fax_number": "619-303-8152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 CAMINO DEL RIO N STE 211",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921081632",
            "telephone_number": "619-754-0328",
            "fax_number": "619-303-8152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKETT",
        "first_name": "ROBERTA",
        "credential": "LEP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-03",
        "last_updated": "2014-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CA",
            "license": "LEP3395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2014; 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.