Active NPI
Stephen Haynes Carlson, PSYD
- Clinical Psychologist
- Oakland, CA
National Provider Identifier
1174758569
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 27819
- Practice address
- 298 Grand Ave
#100
Oakland, CA 94610-4724 - Phone
- (510) 566-1076
- NPI assigned
- May 28, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 | PSY 27819 | CA | Primary |
Addresses
Primary practice location
298 Grand Ave
#100
Oakland, CA 94610-4724
Mailing address
2446 24TH Ave
Oakland, CA 94601-1267
Phone (510) 566-1076
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 |
|---|---|---|---|
| PSY 27819 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1243468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473984000000",
"number": "1174758569",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2446 24TH AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946011267",
"telephone_number": "510-566-1076"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "298 GRAND AVE",
"address_2": "#100",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946104724",
"telephone_number": "510-566-1076"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "STEPHEN",
"middle_name": "HAYNES",
"name_prefix": "Mr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-28",
"last_updated": "2016-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 27819",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.