Active NPI
Stephanie Pratola, PH.D
- Clinical Psychologist
- Roanoke, VA
National Provider Identifier
1164533139
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810001014
- Practice address
- 2017 Jefferson St SW
Roanoke, VA 24014-2419 - Phone
- (540) 853-0900
- Fax
- (540) 853-0518
- NPI assigned
- Aug 31, 2006
- 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 | 0810001014 | VA | Primary |
Addresses
Primary practice location
2017 Jefferson St SW
Roanoke, VA 24014-2419
Mailing address
2017 Jefferson St SW
Roanoke, VA 24014-2419
Phone (540) 853-0863
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007728581 | Medicaid | VA |
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810001014 | VA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545782400000",
"number": "1164533139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2017 JEFFERSON ST SW",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240142419",
"telephone_number": "540-853-0863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2017 JEFFERSON ST SW",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240142419",
"telephone_number": "540-853-0900",
"fax_number": "540-853-0518"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRATOLA",
"first_name": "STEPHANIE",
"credential": "PH.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2018-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810001014",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "007728581",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roanoke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.