Active NPI
Steven R Edelman, MA
- Clinical Psychologist
- Fayetteville, NC
National Provider Identifier
1184750655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 364
- Practice address
- 907 Hay St Ste 203
Fayetteville, NC 28305-5352 - Phone
- (910) 826-3694
- Fax
- (910) 486-1590
- NPI assigned
- Feb 26, 2007
- Last updated
- Feb 7, 2014
- 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 | 364 | NC | Primary |
Addresses
Primary practice location
907 Hay St Ste 203
Fayetteville, NC 28305-5352
Mailing address
345 Lochstone CT
Fayetteville, NC 28303-5139
Phone (910) 868-6565
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6107011 | Medicaid | NC |
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 364 | NC | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Alternative Housing, Inc. | Past | Accepting new patients | |
| Alternative Care Treatment Systems, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Fayetteville, NC
- NPI 1548514219
-
- Community/Behavioral Health Agency
- Fayetteville, NC
- NPI 1417383704
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391731200000",
"number": "1184750655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "345 LOCHSTONE CT",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283035139",
"telephone_number": "910-868-6565",
"fax_number": "910-486-1590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "907 HAY ST STE 203",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283055352",
"telephone_number": "910-826-3694",
"fax_number": "910-486-1590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDELMAN",
"first_name": "STEVEN",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-26",
"last_updated": "2014-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "364",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6107011",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
- Eckerd Corporation (Rite Aid Pharmacy 11502)
- Eckerd Corporation (Rite Aid Pharmacy 11504)
- Edc Drug Stores (Rite Aid Pharmacy 11507)
- Edc Drug Stores (Rite Aid Pharmacy 11505)
- Meaghan Marie Eberly Eddy, FNP
- Eve Saucier Eder
- Hagen Elizabeth Edgar, MSW, LCSWA
- Dustin Todd Edge, PHARMD
- Jenny Campbell Edgemon, M.S., CCC-A
- Faith Marie Edgren, LCSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.