Active NPI
Matthew Stefonetti, PSYD
- Clinical Psychologist
- Bath, NY
National Provider Identifier
1376280792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS019577
- Practice address
- 76 Veterans Ave
Bath, NY 14810-0810 - Phone
- (607) 664-4000
- NPI assigned
- May 17, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS019577 | PA | Primary |
Addresses
Primary practice location
76 Veterans Ave
Bath, NY 14810-0810
Mailing address
1073 Sing Sing Rd Apt E5
Horseheads, NY 14845-1394
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS019577 | PA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652745600000",
"number": "1376280792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1073 SING SING RD APT E5",
"city": "HORSEHEADS",
"state": "NY",
"postal_code": "148451394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "76 VETERANS AVE",
"city": "BATH",
"state": "NY",
"postal_code": "148100810",
"telephone_number": "607-664-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEFONETTI",
"first_name": "MATTHEW",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-05-17",
"last_updated": "2022-05-17",
"certification_date": "2022-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS019577",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bath, NY
- Snell Farm Childrens Center
- Lynne Snyder
- Michael Speziale
- Aimee Lynne Stanislawski, M.D.
- State of New York Comptrollers Office
- Ellen Stephens
- Steuben County
- Steuben County Office for the Aging
- Steuben County, Dba Steuben County Community Services Substance &Alcoh
- Steuben Health Care Equipment Supply and Service Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 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.