Jane Stafford, PH.D.
Individual provider Active NPI Psychologist · Aiken, SC
NPI 1730456740 · NPPES record last updated Nov 18, 2011
Key facts
- NPI
- 1730456740
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 1008 (SC)
- Practice address
- 33 Varden Dr
Aiken, SC 29803-5285 - Phone
- (803) 642-3801
- NPI assigned
- Nov 18, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131108000665 | SC | Practitioner - Clinical Psychologist | 8527293059 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1008 | SC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neighborhood Improvement Project Inc | Current |
Accepting new patients | |
| Neighborhood Improvement Project Inc | Current |
Accepting new patients | |
| Aiken Psychiatric and Psychotherapy Associates PA | Current |
Accepting new patients | |
| Aiken Psychotherapy | Past | Accepting new patients |
Locations
2467 Golden Camp Rd
Augusta, GA 30906
Phone (706) 922-0682
33 Varden Dr
Aiken, SC 29803
Phone (803) 642-3801
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1008 | SC | Yes |
Addresses
Primary practice location
33 Varden Dr
Aiken, SC 29803-5285
Mailing address
33 Varden Dr
Aiken, SC 29803-5285
Phone (803) 642-3801
Other providers in Aiken, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.