Roberta Bassett Corson, PH.D.

Primary specialty

Adult Development & Aging PsychologistTaxonomy code 103TA0700X

License

PSY18128 Issued in CA

Practice address

4010 Moorpark Ave
Suite 206
San Jose, CA 95117-4101

Phone

(408) 247-1774

NPI assigned

May 19, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 1, 2016 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1179532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1881802080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4010 MOORPARK AVE",
            "address_2": "SUITE 206",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951174101",
            "telephone_number": "408-247-1774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 MOORPARK AVE",
            "address_2": "SUITE 206",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951174101",
            "telephone_number": "408-247-1774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORSON",
        "first_name": "ROBERTA",
        "middle_name": "BASSETT",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-19",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "CA",
            "license": "PSY18128",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY18128",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "CA",
            "license": "PSY18128",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Correia
• Jacqueline Corres, FNP
• Christopher Corsa, DMD, MS
• Victor Corsiglia, M.D.
• Crystal Corso
• Enrique Cortes Dimas, OTR/L
• Alejandra Cortes
• Erika Cortes
• Gerardo Cortes
• Jasmin Mia Cortes

• Adult Development & Aging Psychologist in San Jose, CA
• Providers in San Jose, CA by specialty
• Adult Development & Aging Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.