Active NPI
Joseph Matthew Stabrava, MA TLLP
- Clinical Psychologist
- Southfield, MI
National Provider Identifier
1457745234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301015967
- Practice address
- 21221 Poinciana St
Southfield, MI 48033-5043 - Phone
- (248) 820-8359
- NPI assigned
- Mar 19, 2015
- Last updated
- Oct 28, 2024
- Sex
- Male
- 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 | 6301015967 | MI | Primary |
Addresses
Primary practice location
21221 Poinciana St
Southfield, MI 48033-5043
Mailing address
21221 Poinciana St
Southfield, MI 48033-5043
Phone (248) 820-8359
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
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301015967 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730073600000",
"number": "1457745234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21221 POINCIANA ST",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480335043",
"telephone_number": "248-820-8359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21221 POINCIANA ST",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480335043",
"telephone_number": "248-820-8359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STABRAVA",
"first_name": "JOSEPH",
"middle_name": "MATTHEW",
"credential": "MA TLLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-03-19",
"last_updated": "2024-10-28",
"certification_date": "2024-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301015967",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.