Active NPI
Stephanie Dubina, PSY.D.
- Clinical Psychologist
- Victor, NY
National Provider Identifier
1063886455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 05654
- Practice address
- 6539 Anthony Dr Ste a
Victor, NY 14564-1441 - Phone
- (585) 398-8835
- Fax
- (585) 398-7376
- NPI assigned
- Nov 23, 2015
- Last updated
- Jun 14, 2023
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 05654 | MD | Primary |
Addresses
Primary practice location
6539 Anthony Dr Ste a
Victor, NY 14564-1441
Mailing address
1708 W Rogers Ave
Baltimore, MD 21209-4545
Phone (410) 578-5087
Other practice location 1
1160 Pittsford Victor Rd Ste F
Pittsford, NY 14534-3825
Phone (585) 398-8835
Other practice location 2
1708 W Rogers Ave
Baltimore, MD 21209-4545
Phone (410) 578-5087
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 025567 | Other | NY | PROFESSIONAL LICENSE |
Other names 1
- Stephanie Terracciano
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05654 | MD | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1448236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686700800000",
"number": "1063886455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1708 W ROGERS AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212094545",
"telephone_number": "410-578-5087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6539 ANTHONY DR STE A",
"city": "VICTOR",
"state": "NY",
"postal_code": "145641441",
"telephone_number": "585-398-8835",
"fax_number": "585-398-7376"
}
],
"practiceLocations": [
{
"address_1": "1160 Pittsford Victor Rd Ste F",
"address_purpose": "LOCATION",
"city": "Pittsford",
"state": "NY",
"postal_code": "145343825",
"country_code": "US",
"telephone_number": "585-398-8835",
"fax_number": "585-398-7376",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1708 W Rogers Ave",
"address_purpose": "LOCATION",
"city": "Baltimore",
"state": "MD",
"postal_code": "212094545",
"country_code": "US",
"telephone_number": "410-578-5087",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DUBINA",
"first_name": "STEPHANIE",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-11-23",
"last_updated": "2023-06-14",
"certification_date": "2023-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "05654",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROFESSIONAL LICENSE",
"identifier": "025567",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "STEPHANIE",
"last_name": "TERRACCIANO",
"credential": "PSY.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Victor, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.