Active NPI
Carly B Blackstone, PSY.D.
- Clinical Psychologist
- Arlington, VA
National Provider Identifier
1508010182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810003993
- Practice address
- 46 S Glebe Rd
Suite 103
Arlington, VA 22204-1655 - Phone
- (703) 521-6004
- Fax
- (701) 521-6342
- NPI assigned
- Nov 10, 2008
- Last updated
- Nov 10, 2008
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810003993 | VA | Primary |
Addresses
Primary practice location
46 S Glebe Rd
Suite 103
Arlington, VA 22204-1655
Mailing address
46 S Glebe Rd
Suite 103
Arlington, VA 22204-1655
Phone (703) 521-6004
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810003993 | VA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Renascence Center, LLC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226275200000",
"number": "1508010182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "46 S GLEBE RD",
"address_2": "SUITE 103",
"city": "ARLINGTON",
"state": "VA",
"postal_code": "222041655",
"telephone_number": "703-521-6004",
"fax_number": "701-521-6342"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "46 S GLEBE RD",
"address_2": "SUITE 103",
"city": "ARLINGTON",
"state": "VA",
"postal_code": "222041655",
"telephone_number": "703-521-6004",
"fax_number": "701-521-6342"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKSTONE",
"first_name": "CARLY",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-11-10",
"last_updated": "2008-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810003993",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arlington, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.