Active NPI
Robert James Mittan, PH.D.
- Psychologist
- Stanley, NC
National Provider Identifier
1730483272
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1433
- Practice address
- 7316 Oxford Bluff Dr
Stanley, NC 28164-6813 - Phone
- (704) 966-0246
- NPI assigned
- Dec 24, 2010
- Last updated
- Dec 24, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1433 | NC | Primary |
| Psychologist | 103T00000X | PF7768 | CA |
Addresses
Primary practice location
7316 Oxford Bluff Dr
Stanley, NC 28164-6813
Mailing address
7316 Oxford Bluff Dr
Stanley, NC 28164-6813
Phone (704) 966-0246
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
| License | State | Type | Specialty |
|---|---|---|---|
| PF7768 | CA | MD | Psychologist |
| 1433 | NC | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1293148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1293148800000",
"number": "1730483272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7316 OXFORD BLUFF DR",
"city": "STANLEY",
"state": "NC",
"postal_code": "281646813",
"telephone_number": "704-966-0246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7316 OXFORD BLUFF DR",
"city": "STANLEY",
"state": "NC",
"postal_code": "281646813",
"telephone_number": "704-966-0246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITTAN",
"first_name": "ROBERT",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-12-24",
"last_updated": "2010-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "1433",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PF7768",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stanley, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.