Stephen Edward Nassar, PSYD, LCSW

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY6228 Issued in FL

Practice address

3684 N Wickham Rd
Suite B
Melbourne, FL 32935-2328

Phone

(321) 751-3636

Fax

(321) 751-8108

NPI assigned

Jul 17, 2006

Last updated

Oct 17, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 1, 2025 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stephen E Nassar Psy D LCSW P a

  • Psychologist
  • Melbourne, FL
  • NPI 1659305571
  Authorized official Same address or phone

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1790703973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3684 N WICKHAM RD",
            "address_2": "SUITE B",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329352328",
            "telephone_number": "321-751-3636",
            "fax_number": "321-751-8108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3684 N WICKHAM RD",
            "address_2": "SUITE B",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329352328",
            "telephone_number": "321-751-3636",
            "fax_number": "321-751-8108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NASSAR",
        "first_name": "STEPHEN",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "PSYD, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY6228",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW3802",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE PROVIDER NUMBER",
            "identifier": "134222541",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "54815",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; 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.

Verify at the official NPI Registry.