Roger Kenneth Light, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY9830 Issued in CA

Practice address

509 N Sepulveda Blvd
Suite 204
Manhattan Beach, CA 90266-6746

Phone

(310) 374-1221

Fax

(310) 214-0648

NPI assigned

Apr 25, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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 Feb 24, 2022 through Feb 24, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr. Lori Zaremski, PHD

  • Psychologist
  • Manhattan Beach, CA
  • NPI 1831558899
  NPD (past)
• UC Regents

  dba UCLA Neuropsychiatric Behavioral Health

  • Adult Development & Aging Psychologist
  • Los Angeles, CA
  • NPI 1750368999
  NPD (past)

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992924047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 N SEPULVEDA BLVD",
            "address_2": "SUITE 204",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902666746",
            "telephone_number": "310-374-1221",
            "fax_number": "310-214-0648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 N SEPULVEDA BLVD",
            "address_2": "SUITE 204",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902666746",
            "telephone_number": "310-374-1221",
            "fax_number": "310-214-0648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIGHT",
        "first_name": "ROGER",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY9830",
            "primary": true
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "HI",
            "license": "PSY819",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Levine Therapy, Licensed Professional Clinical Counselor, PC
• Wendy Ann Lewis, MFT
• Kenneth Li
• Gina Lieu, OD
• Rachel Liger, RD
• Lightning Cal Healthcare Services Inc.
• Jacqueline Lim, PHARM.D.
• Sean Limahelu, PT, DPT
• Vivian Yi Lin
• Linda Yoon Licensed Clinical Social Worker, Inc. (Yellow Chair Collective)

• Clinical Neuropsychologist in Manhattan Beach, CA
• Providers in Manhattan Beach, CA by specialty
• Clinical Neuropsychologist in California

• 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; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.