Active NPI
Stefanie Platt
- Clinical Psychologist
- San Ysidro, CA
National Provider Identifier
1326371501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 25962
- Practice address
- 4004 Beyer Blvd
San Ysidro, CA 92173-2007 - Phone
- (619) 662-4100
- NPI assigned
- Sep 6, 2009
- Sex
- Female
- 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 25962 | CA | Primary |
Addresses
Primary practice location
4004 Beyer Blvd
San Ysidro, CA 92173-2007
Mailing address
1275 30TH St
San Diego, CA 92154-3476
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25962 | CA | MD | Mental Health Counselor |
| PSY 25962 | CA | MD | Clinical Psychologist |
Interoperability endpoints
- stefanie.platt.1@30730.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408406400000",
"number": "1326371501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1275 30TH ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921543476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4004 BEYER BLVD",
"city": "SAN YSIDRO",
"state": "CA",
"postal_code": "921732007",
"telephone_number": "619-662-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PLATT",
"first_name": "STEFANIE",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-06",
"last_updated": "2014-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 25962",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Ysidro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.