Stephen Thomas Black, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY 21055 Issued in CA

Practice address

1 University Cir
Csu Stanislaus
Turlock, CA 95382-3200

Phone

(209) 667-3065

NPI assigned

Aug 18, 2009

Last updated

Aug 18, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• California State University Stanislaus

  • Clinic Pharmacy
  • Turlock, CA
  • NPI 1528195393
  NPD (past)
• California State University, Stanislaus Student Health Center

  • Student Health Clinic/Center
  • Turlock, CA
  • NPI 1841338191
  NPD (past)

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

{
    "created_epoch": "1250553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250553600000",
    "number": "1417189846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "764 EDGEMAR AVE",
            "city": "PACIFICA",
            "state": "CA",
            "postal_code": "940442319",
            "telephone_number": "650-359-1678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 UNIVERSITY CIR",
            "address_2": "CSU STANISLAUS",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953823200",
            "telephone_number": "209-667-3065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "STEPHEN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-08-18",
        "last_updated": "2009-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY  21055",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MS",
            "license": "PSY  46754",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James A Biedenweg, BS PHARMACY
• Brian R. Bigelow, MD
• Gowri Bilva
• Biosport Physical Therapy Turlock Inc.
• Mandeep Kaur Birk, LVN
• Jordan Christine Blevins
• Blooming Roses Inc. (Blooming Roses Home Health)
• Bo Gu MD Inc
• Brandi Renee Boehme
• Boies Pharmacy Inc (Boies Medical Center Pharmacy)

• Psychologist in Turlock, CA
• Providers in Turlock, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.