Stephen Carl Ganderson, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810001638 Issued in VA

Practice address

505 Cedar Rd
Suite B-1
Chesapeake, VA 23322-5585

Phone

(757) 548-9996

Fax

(757) 382-5085

NPI assigned

Oct 11, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902994262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2739",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233272739",
            "telephone_number": "757-548-9996",
            "fax_number": "757-382-5085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 CEDAR RD",
            "address_2": "SUITE B-1",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233225585",
            "telephone_number": "757-548-9996",
            "fax_number": "757-382-5085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANDERSON",
        "first_name": "STEPHEN",
        "middle_name": "CARL",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810001638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7704755",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James J Gallo, MD
• Gladys Gicelle Galvez, NONE
• Eileen Mary Galvin
• Britnee Gamboni
• Lawanda R Gammon
• Aimee L Gannon, PA
• April Monique Gantt, NONE
• Keitza Garavito Amador, DC
• Anna Elizabeth Garcia
• Gardens Pharmacy

• Clinical Psychologist in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.