Stephen Dale Blakeman, M.A.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1556 Issued in NC

Practice address

1012 Cedar Knoll Dr
Wake Forest, NC 27587-6248

Phone

(919) 554-4343

Fax

(877) 300-6893

NPI assigned

Jun 13, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211241600000",
    "number": "1972507309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 CEDAR KNOLL DR",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275876248",
            "telephone_number": "919-554-4343",
            "fax_number": "877-300-6893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 CEDAR KNOLL DR",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275876248",
            "telephone_number": "919-554-4343",
            "fax_number": "877-300-6893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKEMAN",
        "first_name": "STEPHEN",
        "middle_name": "DALE",
        "name_prefix": "Mr.",
        "credential": "M.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-13",
        "last_updated": "2008-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "1556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "142A0",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6107254",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Bishop, PA-C
• Tonya Blache, MD
• Camilla Yvette Black, M.ED, NCC,LPC
• April Blackford, FDN-P
• Judith Ann Blaine, CCC - SLP
• George Bryan Blalock, R.PH.
• Bloom Joy LLC
• Blue Homecare Services LLC
• Larry Elbert Bobbitt
• Jonathan Edmund Boes, D.D.S.

• Clinical Psychologist in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; 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.