Active NPI
Ryan Stubblefield, PSYD
- Clinical Psychologist
- Berkeley, CA
National Provider Identifier
1942023353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 35316
- Practice address
- 2340 Ward St Ste 204
Berkeley, CA 94705-1147 - Phone
- (415) 689-8806
- NPI assigned
- Nov 4, 2024
- 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 | 35316 | CA | Primary |
Addresses
Primary practice location
2340 Ward St Ste 204
Berkeley, CA 94705-1147
Mailing address
2340 Ward St Ste 204
Berkeley, CA 94705-1147
Phone (415) 689-8806
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35316 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730678400000",
"number": "1942023353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2340 WARD ST STE 204",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947051147",
"telephone_number": "415-689-8806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2340 WARD ST STE 204",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947051147",
"telephone_number": "415-689-8806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STUBBLEFIELD",
"first_name": "RYAN",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-11-04",
"last_updated": "2024-11-04",
"certification_date": "2024-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "35316",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.