Stephen Miksic, PH.D.

Primary specialty

Forensic PsychologistTaxonomy code 103TF0200X

License

PS004073L Issued in PA

Practice address

35 Princeton Rd
Havertown, PA 19083-3621

Phone

(610) 584-9721

Fax

(610) 584-9721

NPI assigned

Feb 11, 2007

Sex

Male

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 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1171152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1184765125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32799 OCEAN REACH DR",
            "city": "LEWES",
            "state": "DE",
            "postal_code": "199584663",
            "telephone_number": "610-716-6590",
            "fax_number": "302-200-7432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 PRINCETON RD",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190833621",
            "telephone_number": "610-584-9721",
            "fax_number": "610-584-9721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKSIC",
        "first_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-11",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "PA",
            "license": "PS004073L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED PSYCHOLOGIST",
            "identifier": "PS004073-L",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "drmiksic@gmail.com",
            "affiliation": "N",
            "endpointDescription": "computer",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "35 Princeton Rd",
            "city": "Havertown",
            "state": "PA",
            "country_code": "US",
            "postal_code": "190833621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Forensic Psychologist in Havertown, PA
• Providers in Havertown, PA by specialty
• Forensic Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; 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.