Individual provider Active NPI

Stephen William Smith, PH.D.

  • Clinical Psychologist
  • Virginia Beach, VA
National Provider Identifier
1386019867
Registry record updated Sep 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
0810005262 Issued in VA
Practice address
2716 Chester Forest CT
Virginia Beach, VA 23452-7709
Phone
(757) 708-0241
NPI assigned
Dec 9, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 9, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 0810005262 VA Primary

Addresses

Primary practice location

2716 Chester Forest CT
Virginia Beach, VA 23452-7709

Mailing address

2716 Chester Forest CT
Virginia Beach, VA 23452-7709
Phone (757) 708-0241

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231128000103 VA Practitioner - Clinical Psychologist 3678921970 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
0810005262VAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Specialty Group PLLC CurrentSince Oct 1, 2023 Accepting new patients

Locations

500 Discovery Dr
Chesapeake, VA 23320
Phone (757) 668-2311

11783 Rock Landing Dr
Newport News, VA 23606
Phone (757) 668-6550

850 Southampton Ave
Norfolk, VA 23510
Phone (757) 668-4673

601 Childrens Ln
Norfolk, VA 23507
Phone (757) 668-7272

620 John Paul Jones Cir
Portsmouth, VA 23708
Phone (757) 953-0669

2021 Concert Dr
Virginia Beach, VA 23456
Phone (757) 668-6550

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1449619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1386019867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2716 CHESTER FOREST CT",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527709",
            "telephone_number": "757-708-0241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2716 CHESTER FOREST CT",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527709",
            "telephone_number": "757-708-0241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "STEPHEN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-12-09",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810005262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.