Active NPI
Stephanie Jefferson, PSY.D.
- Psychologist
- San Bernardino, CA
National Provider Identifier
1578700050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY13588
- Practice address
- 202 E Airport Dr
Suite 175
San Bernardino, CA 92408-3444 - Phone
- (909) 890-2299
- Fax
- (909) 890-2469
- NPI assigned
- Jan 20, 2009
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY13588 | CA | Primary |
Addresses
Primary practice location
202 E Airport Dr
Suite 175
San Bernardino, CA 92408-3444
Mailing address
202 E Airport Dr
Suite 175
San Bernardino, CA 92408-3444
Phone (909) 890-2299
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 |
|---|---|---|---|
| PSY13588 | CA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Genesis Counseling Service | 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 and National Provider Directory roles.
-
- Marriage & Family Therapist
- Ridgecrest, CA
- NPI 1417134123
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232409600000",
"number": "1578700050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 E AIRPORT DR",
"address_2": "SUITE 175",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924083444",
"telephone_number": "909-890-2299",
"fax_number": "909-890-2469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 E AIRPORT DR",
"address_2": "SUITE 175",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924083444",
"telephone_number": "909-890-2299",
"fax_number": "909-890-2469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEFFERSON",
"first_name": "STEPHANIE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-20",
"last_updated": "2009-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY13588",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.