Active NPI
Kristin Dezen, PHD
- Psychologist
- Melbourne, FL
National Provider Identifier
1891203642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 9754
- Practice address
- 141 Beth LN Apt 264
Melbourne, FL 32904-5044 - Phone
- (585) 697-4143
- NPI assigned
- Jan 15, 2018
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 9754 | FL | Primary |
Addresses
Primary practice location
141 Beth LN Apt 264
Melbourne, FL 32904-5044
Mailing address
135 Westway Apt 204
Greenbelt, MD 20770-1939
Phone (585) 697-4143
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9754 | FL | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Over the Rainbow LLC | 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.
-
- Community/Behavioral Health Agency
- Washington, DC
- NPI 1255666145
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515974400000",
"number": "1891203642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "135 WESTWAY APT 204",
"city": "GREENBELT",
"state": "MD",
"postal_code": "207701939",
"telephone_number": "585-697-4143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "141 BETH LN APT 264",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329045044",
"telephone_number": "585-697-4143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEZEN",
"first_name": "KRISTIN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-15",
"last_updated": "2018-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "9754",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 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.