DR. KIMBERLEE DAWN DERUSHIA PSYD
NPI 1437867769
Psychologist - Clinical in Stockton, CA

Q: What is Kimberlee Derushia's NPI number?

The NPI number for Kimberlee Derushia is 1437867769. It was assigned to this individual provider in the NPPES registry on November 7, 2022.

Q: What is Kimberlee Derushia's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: Is Kimberlee Derushia enrolled in Medicare?

No. Kimberlee Derushia has opted out of Medicare through May 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Active since November 07, 2022Opted out of Medicare · through May 1, 2028

1111 W ROBINHOOD DR STE G, STOCKTON, CA 95207(209) 701-0105 Get Directions Write a Review

NPPES record last updated: August 9, 2024. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Aug 9, 2024, Nov 7, 2022 (2 updates tracked since 2022).

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About Dr. Kimberlee Dawn Derushia Psyd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KIMBERLEE DAWN DERUSHIA PSYD (NPI 1437867769) is an individual clinical provider in Stockton, California, licensed in California (PSY24992) and active in the NPI registry since November 2022. She has opted out of Medicare through May 1, 2028.

NPPES Registry Identity

NPI1437867769

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameDR. KIMBERLEE DAWN DERUSHIACredential: PSYD

Location Address1111 W ROBINHOOD DR STE GStockton, CA 95207-5626

Mailing Address1111 W Robinhood Dr Ste GStockton, CA 95207-5626 · (209) 701-0105

Phone(209) 701-0105

Sole ProprietorYes

Enumeration DateNovember 7, 2022

Last NPPES UpdateAugust 9, 20242 updates tracked since enumeration

NPPES CertifiedAugust 9, 2024

✔ NPI 1437867769 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

Licenses✔ Licensed in CA · PSY24992✔ Licensed in CA · 24992

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

1111 W ROBINHOOD DR STE G, Stockton, CA 95207

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Kimberlee Dawn Derushia Psyd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from May 1, 2024 through May 1, 2028.

Opt-Out Effective DateMay 1, 2024

Opt-Out In Effect ThroughMay 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kimberlee Derushia's NPI number?

The NPI number for Kimberlee Derushia is 1437867769. It was assigned to this individual provider in the NPPES registry on November 7, 2022.

Where is Kimberlee Derushia located?

Kimberlee Derushia practices at 1111 W Robinhood Dr Ste G, Stockton, CA 95207. The listed phone number is (209) 701-0105.

What is Kimberlee Derushia's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Kimberlee Derushia enrolled in Medicare?

No. Kimberlee Derushia has opted out of Medicare through May 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Kimberlee Derushia was last updated on August 9, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.