NPIMap

Organization Active NPI

Stacey Belmont, PHD and Associates, LLC

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1013342732
Registry record updated Jan 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071008266 Issued in IL
Legal business name
STACEY BELMONT, PHD AND ASSOCIATES, LLC
Practice address
3166 N Lincoln Ave
Suite 217
Chicago, IL 60657-3133
Phone
(708) 406-9870
NPI assigned
Sep 12, 2013
Last updated
Jan 28, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2014

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

Authorized official

Name
Dr. Stacey RJ Belmont, PHD
Title
Clinical Psychologist
Phone
(708) 406-9870

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 071008266 IL Primary

Addresses

Primary practice location

3166 N Lincoln Ave
Suite 217
Chicago, IL 60657-3133

Mailing address

3166 N Lincoln Ave
Suite 217
Chicago, IL 60657-3133
Phone (708) 406-9870

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131205000552 IL Part B Supplier - Clinic/Group Practice 4284861881 Receives reassigned benefits from 2 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

3166 N Lincoln Ave
Ste 317
Chicago, IL 60657
Phone (708) 406-9870

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1378944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390867200000",
    "number": "1013342732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3166 N LINCOLN AVE",
            "address_2": "SUITE 217",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606573133",
            "telephone_number": "708-406-9870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3166 N LINCOLN AVE",
            "address_2": "SUITE 217",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606573133",
            "telephone_number": "708-406-9870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACEY BELMONT, PHD AND ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-12",
        "last_updated": "2014-01-28",
        "status": "A",
        "authorized_official_last_name": "BELMONT",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "RJ",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "708-406-9870",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.