Active NPI
Stephanie Carlson, PSYCHOLOGIST
- Clinical Psychologist
- Bronx, NY
National Provider Identifier
1508977950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 010343-1
- Practice address
- 5676 Riverdale Ave
Ste. 202
Bronx, NY 10471-2138 - Phone
- (718) 796-5300
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 010343-1 | NY | Primary |
Addresses
Primary practice location
5676 Riverdale Ave
Ste. 202
Bronx, NY 10471-2138
Mailing address
5676 Riverdale Ave
Ste. 202
Bronx, NY 10471-2138
Phone (718) 796-5300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Aug 20, 2024 through Aug 20, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010343-1 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508977950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5676 RIVERDALE AVE",
"address_2": "STE. 202",
"city": "BRONX",
"state": "NY",
"postal_code": "104712138",
"telephone_number": "718-796-5300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5676 RIVERDALE AVE",
"address_2": "STE. 202",
"city": "BRONX",
"state": "NY",
"postal_code": "104712138",
"telephone_number": "718-796-5300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "STEPHANIE",
"credential": "PSYCHOLOGIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "010343-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.