Active NPI
Stefanie Glennon
- Clinical Psychologist
- New York, NY
National Provider Identifier
1700455607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 007762-1
- Practice address
- 12 W 72ND St Apt 4E
New York, NY 10023-4164 - Phone
- (917) 533-0558
- Fax
- (212) 496-0369
- NPI assigned
- Jun 23, 2021
- 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 | 007762-1 | NY | Primary |
Addresses
Primary practice location
12 W 72ND St Apt 4E
New York, NY 10023-4164
Mailing address
12 W 72ND St Apt 4E
New York, NY 10023-4164
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 5, 2016 through Aug 5, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007762-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624406400000",
"number": "1700455607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 W 72ND ST APT 4E",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100234164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 W 72ND ST APT 4E",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100234164",
"telephone_number": "917-533-0558",
"fax_number": "212-496-0369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLENNON",
"first_name": "STEFANIE",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-06-23",
"last_updated": "2021-06-23",
"certification_date": "2021-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "007762-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; 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.