Mary Stevens, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP0970 Issued in MN

Practice address

7101 York Ave S
Suite 161
Edina, MN 55435-4450

Phone

(652) 921-9964

NPI assigned

Apr 20, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291334400000",
    "number": "1104881051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7101 YORK AVE S",
            "address_2": "SUITE 161",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354450",
            "telephone_number": "652-921-9964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7101 YORK AVE S",
            "address_2": "SUITE 161",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354450",
            "telephone_number": "652-921-9964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "MARY",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-20",
        "last_updated": "2010-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP0970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "16890ST",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "476347500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carol Margaret Stephens, LP
• Jeffrey J Stephens, M.D.
• Kelly Sternhagen
• Elaine Theresa Stevens, CNS
• Erin Renae Stevens, MD
• Shonni Stevens, RD
• Christine Elyse Stewart, M.D.
• Dana Michelle Stewart, MSW, LICSW
• Eric F Stich, D.D.S.
• Angela Marie Stock, PT

• Psychologist in Edina, MN
• Providers in Edina, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.