Stephon Proctor, PH.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PS017272 Issued in PA

Practice address

3440 Market St
Suite 200
Philadelphia, PA 19104-3325

Phone

(215) 590-7555

NPI assigned

Jul 1, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Childrens Hospital of Philadelphia Practice Association

  • Child & Adolescent Psychiatry Physician
  • Philadelphia, PA
  • NPI 1477645232
  NPD (past)

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

{
    "created_epoch": "1277942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375401600000",
    "number": "1134430457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3440 MARKET ST",
            "address_2": "SUITE 200",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191043325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3440 MARKET ST",
            "address_2": "SUITE 200",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191043325",
            "telephone_number": "215-590-7555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "STEPHON",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-01",
        "last_updated": "2013-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "PA",
            "license": "PS017272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Procare Pharmacy, L.L.C.
• Procare Rehab, P.C.
• Jennifer L Procopio, DO
• Abigail Proctor, CRNP
• Julia Proctor
• Prodigy Home Care LLC
• Alex Proekt
• Craig Profant, MD
• Professional Community Home Care Agency Inc
• Professional Health Care & Rehab. Services

• Clinical Child & Adolescent Psychologist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Clinical Child & Adolescent Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2013; 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.