Steven L. Wise, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY4575 Issued in FL

Practice address

482 Jacksonville Dr
Jacksonville Beach, FL 32250-3812

Phone

(904) 247-3600

NPI assigned

Sep 8, 2009

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• David C Blackmon,PHD,Psych SVC

  • Clinical Neuropsychologist
  • Jacksonville Beach, FL
  • NPI 1538438270
  NPD (past)

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

{
    "created_epoch": "1252368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252368000000",
    "number": "1255664348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 GLEN COVE PL",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823637",
            "telephone_number": "904-994-0997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "482 JACKSONVILLE DR",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503812",
            "telephone_number": "904-247-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "STEVEN",
        "middle_name": "L.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-09-08",
        "last_updated": "2009-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY4575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alesha Wilson, FNP-C
• Katherine Wimberly
• Gary Winfield, MD
• Glynnis Marie Winfree, APRN
• Katherine Mae Efstration Winham, LMFT
• Dineen Helen Wolfersheim
• Women'S Care Florida LLC
• Kathryn Marie Wood, PT, DPT
• Mallory Hannah Wood
• Kristin Woyak, M.ED., CCC-SLP

• Clinical Psychologist in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2009; 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.