Cooper Jordan Roubic

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Practice address

10802 Forest St Apt 22
Garrettsville, OH 44231-1077

Phone

(330) 978-6561

NPI assigned

Dec 4, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1543881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543881600000",
    "number": "1790255669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10802 FOREST ST",
            "city": "GARRETTSVILLE",
            "state": "OH",
            "postal_code": "442311079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10802 FOREST ST APT 22",
            "city": "GARRETTSVILLE",
            "state": "OH",
            "postal_code": "442311077",
            "telephone_number": "330-978-6561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUBIC",
        "first_name": "COOPER",
        "middle_name": "JORDAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-12-04",
        "last_updated": "2018-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Poole-Wilke, RN, BSN, MSN
• Joseph Michael Proya
• Sandra Jane Richmond, RPH
• Steven Riley, DC
• Rite Aid of Ohio Inc
• S.M.Leu MD Inc
• Lynnsey Alexandria Satterlee, CMA
• Kathryn Schauer
• Jacob Sharratt, PHARMD
• Michael Sherer, ATC

• Clinical Child & Adolescent Psychologist in Garrettsville, OH
• Providers in Garrettsville, OH by specialty
• Clinical Child & Adolescent Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2018; 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.