Active NPI
Thomas Wood Stacy, PHD
- Clinical Psychologist
- Columbia, MD
National Provider Identifier
1871591131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1713
- Practice address
- 10784 Hickory Ridge Rd
Columbia, MD 21044-3646 - Phone
- (410) 964-0425
- Fax
- (410) 964-0515
- NPI assigned
- Jul 11, 2005
- Last updated
- Sep 24, 2012
- 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 | 1713 | MD | Primary |
Addresses
Primary practice location
10784 Hickory Ridge Rd
Columbia, MD 21044-3646
Mailing address
10784 Hickory Ridge Rd
Columbia, MD 21044-3646
Phone (410) 964-0425
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1713 | MD | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348444800000",
"number": "1871591131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10784 HICKORY RIDGE RD",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210443646",
"telephone_number": "410-964-0425",
"fax_number": "410-964-0515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10784 HICKORY RIDGE RD",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210443646",
"telephone_number": "410-964-0425",
"fax_number": "410-964-0515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACY",
"first_name": "THOMAS",
"middle_name": "WOOD",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-11",
"last_updated": "2012-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "1713",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.