Active NPI
Matthew Stanley, PH.D
- Clinical Psychologist
- Westlake, OH
National Provider Identifier
1780242974
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- P.07825
- Practice address
- 30628 Detroit Rd Ste 125
Westlake, OH 44145-5844 - Phone
- (440) 821-0051
- NPI assigned
- Jun 3, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | P.07825 | OH | Primary |
Addresses
Primary practice location
30628 Detroit Rd Ste 125
Westlake, OH 44145-5844
Mailing address
30628 Detroit Rd Ste 125
Westlake, OH 44145-5844
Phone (440) 821-0051
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0407106 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P.07825 | OH | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597363200000",
"number": "1780242974",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30628 DETROIT RD STE 125",
"city": "WESTLAKE",
"state": "OH",
"postal_code": "441455844",
"telephone_number": "440-821-0051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30628 DETROIT RD STE 125",
"city": "WESTLAKE",
"state": "OH",
"postal_code": "441455844",
"telephone_number": "440-821-0051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANLEY",
"first_name": "MATTHEW",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-06-03",
"last_updated": "2020-08-14",
"certification_date": "2020-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "P.07825",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0407106",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Westlake, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.