Active NPI
Dylan Stewart
- Psychologist
- Oakland, CA
National Provider Identifier
1215482484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 32853
- Practice address
- 3301 E 12TH St
#259
Oakland, CA 94601-3424 - Phone
- (510) 269-9030
- NPI assigned
- Aug 17, 2016
- Last updated
- Sep 27, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | NU | ||
| Psychologist | 103T00000X | NU | ||
| Psychologist | 103T00000X | 32853 | CA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | NU |
Addresses
Primary practice location
3301 E 12TH St
#259
Oakland, CA 94601-3424
Mailing address
130 Peter Coutts Cir
Stanford, CA 94305-2521
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632700800000",
"number": "1215482484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 PETER COUTTS CIR",
"city": "STANFORD",
"state": "CA",
"postal_code": "943052521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3301 E 12TH ST",
"address_2": "#259",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946013424",
"telephone_number": "510-269-9030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEWART",
"first_name": "DYLAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-17",
"last_updated": "2021-09-27",
"certification_date": "2021-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "32853",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
}
],
"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 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.