Individual provider Active NPI

Emily Smith, PH.D., NCSP

  • School Psychologist
  • Stockton, CA
National Provider Identifier
1639015514
Registry record updated Apr 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
School PsychologistTaxonomy code 103TS0200X
License
250061310 Issued in CA
Practice address
4811 Riverbrook Dr
Stockton, CA 95219-2016
Phone
(209) 953-8450
NPI assigned
Apr 24, 2026
Last updated
Apr 24, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Psychologist 103TS0200X 250061310 CA Primary

Addresses

Primary practice location

4811 Riverbrook Dr
Stockton, CA 95219-2016

Mailing address

4811 Riverbrook Dr
Stockton, CA 95219-2016
Phone (209) 953-8450

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
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
250061310CAMDSchool Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1776988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776988800000",
    "number": "1639015514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4811 RIVERBROOK DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952192016",
            "telephone_number": "209-953-8450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 RIVERBROOK DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952192016",
            "telephone_number": "209-953-8450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "EMILY",
        "credential": "PH.D., NCSP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-04-24",
        "last_updated": "2026-04-24",
        "certification_date": "2026-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "CA",
            "license": "250061310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2026; 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.