Active NPI
Marian Lisa Stern, PHD, CGP, ABPP GROUP
- Clinical Psychologist
- Ny, NY
National Provider Identifier
1396353215
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 012197
- Practice address
- 6 West 74TH Street
Ny, NY 10023 - Phone
- (212) 595-7392
- NPI assigned
- Jul 16, 2020
- Last updated
- Jul 16, 2020
- 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 | 012197 | NY | Primary |
Addresses
Primary practice location
6 West 74TH Street
Ny, NY 10023
Mailing address
6 West 74TH Street
Ny, NY 10023
Phone (212) 595-7392
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 012197 | Other | NY | LICENSE |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012197 | NY | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594857600000",
"number": "1396353215",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 WEST 74TH STREET",
"city": "NY",
"state": "NY",
"postal_code": "10023",
"telephone_number": "212-595-7392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6 WEST 74TH STREET",
"city": "NY",
"state": "NY",
"postal_code": "10023",
"telephone_number": "212-595-7392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STERN",
"first_name": "MARIAN",
"middle_name": "LISA",
"credential": "PHD, CGP, ABPP GROUP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-16",
"last_updated": "2020-07-16",
"certification_date": "2020-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "012197",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "012197",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ny, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.