Active NPI
Suzanne Staccone, PH.D.
- Psychologist
- Alameda, CA
National Provider Identifier
1457590374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY21415
- Practice address
- 3177 Phoenix LN
Alameda, CA 94502-6924 - Phone
- (209) 835-4141
- Fax
- (209) 830-3974
- NPI assigned
- Feb 17, 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY21415 | CA | Primary |
Addresses
Primary practice location
3177 Phoenix LN
Alameda, CA 94502-6924
Mailing address
PO Box 22544
Oakland, CA 94609-5144
Phone (209) 835-4141
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 |
|---|---|---|---|
| PSY21415 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294444800000",
"number": "1457590374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 22544",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946095144",
"telephone_number": "209-835-4141",
"fax_number": "209-830-3974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3177 PHOENIX LN",
"city": "ALAMEDA",
"state": "CA",
"postal_code": "945026924",
"telephone_number": "209-835-4141",
"fax_number": "209-830-3974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACCONE",
"first_name": "SUZANNE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-02-17",
"last_updated": "2011-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY21415",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alameda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.