Active NPI
Norman Werner Roach, PH.D.
- Clinical Psychologist
- Tustin, CA
National Provider Identifier
1881742005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY6594
- Practice address
- 190 El Camino Real Rear
Tustin, CA 92780-3602 - Phone
- (714) 731-6644
- Fax
- (714) 389-9329
- NPI assigned
- Jan 5, 2007
- Sex
- Male
- 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 | PSY6594 | CA | Primary |
Addresses
Primary practice location
190 El Camino Real Rear
Tustin, CA 92780-3602
Mailing address
190 El Camino Real Rear
Tustin, CA 92780-3602
Phone (714) 731-6644
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2020 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY6594 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881742005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 EL CAMINO REAL REAR",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927803602",
"telephone_number": "714-731-6644",
"fax_number": "714-389-9329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "190 EL CAMINO REAL REAR",
"city": "TUSTIN",
"state": "CA",
"postal_code": "927803602",
"telephone_number": "714-731-6644",
"fax_number": "714-389-9329"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROACH",
"first_name": "NORMAN",
"middle_name": "WERNER",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY6594",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.