NPIMap

Organization Active NPI

Stephen P. Davis, PH.D., P.a.

  • Clinical Psychologist
  • Port St Lucie, FL
National Provider Identifier
1831123173
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY 5785 Issued in FL
Legal business name
STEPHEN P. DAVIS, PH.D., P.A.
Practice address
2400 SE Midport Rd
Suite 211
Port St Lucie, FL 34952-4823
Phone
(772) 398-1003
Fax
(772) 398-1772
NPI assigned
Jul 11, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Stephen P. Davis, PH.D.NPI 1134147283
Title
President
Phone
(772) 398-1003

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PY 5785 FL Primary

Addresses

Primary practice location

2400 SE Midport Rd
Suite 211
Port St Lucie, FL 34952-4823

Mailing address

2400 SE Midport Rd
Suite 211
Port St Lucie, FL 34952-4823
Phone (772) 398-1003

Other identifiers 4

IdentifierTypeStateIssuer
125175OtherFLVALUE OPTIONS
10745971OtherFLAETNA
82322OtherFLCIGNA
IP029180OtherFLMAGELLAN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831123173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 SE MIDPORT RD",
            "address_2": "SUITE 211",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349524823",
            "telephone_number": "772-398-1003",
            "fax_number": "772-398-1772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 SE MIDPORT RD",
            "address_2": "SUITE 211",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349524823",
            "telephone_number": "772-398-1003",
            "fax_number": "772-398-1772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN P. DAVIS, PH.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "772-398-1003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY 5785",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "125175",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "10745971",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "82322",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "IP029180",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.