Individual provider Active NPI

Lia Clemente Roley, PSY.D.

  • Clinical Psychologist
  • Phoenix, AZ
National Provider Identifier
1780994228
Registry record updated Jan 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
4151 Issued in AZ
Practice address
10000 N 31St Ave
Ste C-202
Phoenix, AZ 85051-9582
Phone
(602) 997-6635
NPI assigned
Oct 18, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2012

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 4151 AZ
Addiction (Substance Use Disorder) Psychologist 103TA0400X 4151 AZ
Cognitive & Behavioral Psychologist 103TB0200X 4151 AZ
Clinical Psychologist 103TC0700X 4151 AZ Primary
Forensic Psychologist 103TF0200X 4151 AZ
Health Psychologist 103TH0004X 4151 AZ
Rehabilitation Psychologist 103TR0400X 4151 AZ

Addresses

Primary practice location

10000 N 31St Ave
Ste C-202
Phoenix, AZ 85051-9582

Mailing address

10000 N 31St Ave
Ste C-202
Phoenix, AZ 85051-9582
Phone (602) 997-6635

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
4151AZMDOrthopedic Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Catherine S. O'Connell, PC Psychologist Past Accepting new patients
Arizona Behavioral Health Past Accepting new patients
Desert Vista Neuropsychological Specialists, PLLC PastSince Aug 1, 2014 Accepting new patients

Organizations & group practices 3

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": "1287360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326240000000",
    "number": "1780994228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10000 N 31ST AVE",
            "address_2": "STE C-202",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850519582",
            "telephone_number": "602-997-6635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10000 N 31ST AVE",
            "address_2": "STE C-202",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850519582",
            "telephone_number": "602-997-6635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROLEY",
        "first_name": "LIA",
        "middle_name": "CLEMENTE",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-18",
        "last_updated": "2012-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AZ",
            "license": "4151",
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "4151",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "AZ",
            "license": "4151",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": "4151",
            "primary": true
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "AZ",
            "license": "4151",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "AZ",
            "license": "4151",
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "AZ",
            "license": "4151",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; 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.