National Stress Clinic, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

071-005431 Issued in IL

Legal business name

NATIONAL STRESS CLINIC, LLC

Practice address

1201 N Orange St
Suite 600
Wilmington, DE 19801-1155

Phone

(646) 571-8627

NPI assigned

Feb 2, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Tim Jackson

Title

Director

Phone

(646) 571-8627

Specialties & licenses 5

Addresses

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

{
    "created_epoch": "1296604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296604800000",
    "number": "1093011413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 PLEASANT ST",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024591828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 N ORANGE ST",
            "address_2": "SUITE 600",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198011155",
            "telephone_number": "646-571-8627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIONAL STRESS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-02",
        "last_updated": "2011-02-02",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "646-571-8627",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071-005431",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MD",
            "license": "03127",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "WI",
            "license": "2592-057",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "HI",
            "license": "1214",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "MFT (MFC) 37695",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Wilmington, DE
• Providers in Wilmington, DE by specialty
• Psychologist in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.