Active NPI
Sara Rachel Deckelbaum, PSY.D.
- Clinical Psychologist
- Marietta, GA
National Provider Identifier
1871861468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY003522
- Practice address
- 4939 Lower Roswell Rd
Suite B-202
Marietta, GA 30068-4338 - Phone
- (770) 971-3303
- Fax
- (770) 971-3314
- NPI assigned
- Dec 9, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY003522 | GA | Primary |
Addresses
Primary practice location
4939 Lower Roswell Rd
Suite B-202
Marietta, GA 30068-4338
Mailing address
4939 Lower Roswell Rd
Suite B-202
Marietta, GA 30068-4338
Phone (770) 971-3303
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
| License | State | Type | Specialty |
|---|---|---|---|
| PSY003522 | GA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Berger Psychological Services, P.C. | Clinical | Past | Accepting new patients |
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.
-
- Clinical Psychologist
- Marietta, GA
- NPI 1730522038
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323388800000",
"number": "1871861468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4939 LOWER ROSWELL RD",
"address_2": "SUITE B-202",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300684338",
"telephone_number": "770-971-3303",
"fax_number": "770-971-3314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4939 LOWER ROSWELL RD",
"address_2": "SUITE B-202",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300684338",
"telephone_number": "770-971-3303",
"fax_number": "770-971-3314"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DECKELBAUM",
"first_name": "SARA",
"middle_name": "RACHEL",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-09",
"last_updated": "2011-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY003522",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.