Kimberly C Deboer, PSY. D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS016801 Issued in PA

Practice address

134 Broad St
Suite 5
Stroudsburg, PA 18360-1590

Phone

(570) 872-9324

Fax

(570) 872-9325

NPI assigned

Nov 12, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PA

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.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Cynthia L. Roth, LCSW, LLC

  • Clinical Social Worker
  • Stroudsburg, PA
  • NPI 1790902062
  NPD (past)

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

{
    "created_epoch": "1194825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441065600000",
    "number": "1841470465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 BROAD ST",
            "address_2": "SUITE 5",
            "city": "STROUDSBURG",
            "state": "PA",
            "postal_code": "183601590",
            "telephone_number": "570-872-9324",
            "fax_number": "570-872-9325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 BROAD ST",
            "address_2": "SUITE 5",
            "city": "STROUDSBURG",
            "state": "PA",
            "postal_code": "183601590",
            "telephone_number": "570-872-9324",
            "fax_number": "570-872-9325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBOER",
        "first_name": "KIMBERLY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "PSY. D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-12",
        "last_updated": "2015-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC003734",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS016801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "601931565",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102070114",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charmaine E Davis Burton
• Bruce Craig Davis, M.D.
• Sandra Sue De Fino, CCC-SLP
• Eugenie De Ocejo, MD
• Sulagna De, M.D.
• Meridith Deiter, MS LBS BCBA
• Rebecca Hope Deltoro, LCSW
• Jessica Depete, R.AC.
• Destiny Empowerment House and Groups LLC
• Destiny Empowerment House and Groups LLC

• Psychologist in Stroudsburg, PA
• Providers in Stroudsburg, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.