Stefanie Lockhart-Pettaway, PSY.D, MSW

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY 24837 Issued in CA

Practice address

9113 Foothill Blvd Ste 130
Rancho Cucamonga, CA 91730-6565

Phone

(909) 652-0361

Fax

(909) 652-0241

NPI assigned

Nov 1, 2007

Last updated

Jan 14, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

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

• Empowered Living Psychological Services, Inc.

  • Psychologist
  • Rancho Cucamonga, CA
  • NPI 1831653021
  NPD (past) Authorized official
• Collaborative Psychology Group, a Professional Corporation

  dba Dr. Tanika Gayle & Clinical Associates

  • Clinical Psychologist
  • Riverside, CA
  • NPI 1336532340
  NPD (past)

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

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547424000000",
    "number": "1497934871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9113 FOOTHILL BLVD STE 130",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917306565",
            "telephone_number": "909-652-0361",
            "fax_number": "909-652-0241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9113 FOOTHILL BLVD STE 130",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917306565",
            "telephone_number": "909-652-0361",
            "fax_number": "909-652-0241"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5051 Canyon Crest Dr",
            "address_2": "Suite 204",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925076099",
            "country_code": "US",
            "telephone_number": "909-434-6617",
            "fax_number": "951-682-1485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOCKHART-PETTAWAY",
        "first_name": "STEFANIE",
        "name_prefix": "Dr.",
        "credential": "PSY.D, MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-01",
        "last_updated": "2019-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY 24837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Anthony Lizama
• Vickie L Lizardi
• Ivett Lizardo-Gonzalez
• Timothy Loaiza
• Eugene D. Locken, D.O.
• Emilea Marie Lockhart
• Renae Elisa Loera
• Stephanie Lofton
• Diana Loggins
• Jacqueline Alisi Lolie, RN

• Psychologist in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2019; 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.