Benjamin Stillman, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

048.0134146 Issued in VT

Practice address

4697 Main St
Manchester Center, VT 05255-8916

Phone

(802) 768-9136

Fax

(802) 662-2173

NPI assigned

Mar 29, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 7, 2022 through May 7, 2028

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• SVPS Psychiatric Services LLC

  • Psychiatry Physician
  • Birmingham, AL
  • NPI 1447528591
  NPD (past)

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

{
    "created_epoch": "1332979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670112000000",
    "number": "1457627812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 WEST RD STE 150",
            "city": "MANCHESTER CENTER",
            "state": "VT",
            "postal_code": "052556308",
            "telephone_number": "802-491-7645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4697 MAIN ST",
            "city": "MANCHESTER CENTER",
            "state": "VT",
            "postal_code": "052558916",
            "telephone_number": "802-768-9136",
            "fax_number": "802-662-2173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STILLMAN",
        "first_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-29",
        "last_updated": "2022-12-04",
        "certification_date": "2022-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VT",
            "license": "048.0134146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Corinne Squire, DDS
• Mary Jaeger Stacy, FNP
• April B. Stein, PH.D.
• Step Ahead ABA VT LLC
• Thomas A Sterling, DO
• Taconic Orthopaedics PC
• Kimberly Jean Thomas, PHARMD
• Makayla Sharee Towne
• Kelsey Towslee, ATC
• Xandra H Velenchik, D.M.D.

• Clinical Psychologist in Manchester Center, VT
• Providers in Manchester Center, VT by specialty
• Clinical Psychologist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.