Gerry Stefanatos, D.PHIL.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PS005335L Issued in PA

Practice address

7948 Montgomery Ave
Elkins Park, PA 19027-2644

Phone

(215) 964-0756

NPI assigned

Sep 9, 2015

Last updated

Sep 9, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1441756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441756800000",
    "number": "1992173884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7948 MONTGOMERY AVE",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190272644",
            "telephone_number": "215-964-0756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7948 MONTGOMERY AVE",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190272644",
            "telephone_number": "215-964-0756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEFANATOS",
        "first_name": "GERRY",
        "credential": "D.PHIL.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-09",
        "last_updated": "2015-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "PA",
            "license": "PS005335L",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "PA",
            "license": "PS005335L",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "PA",
            "license": "PS005335L",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Susan Strasbaugh
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• Susan Deikman LLC
• Justin Rudolph Sutter

• Clinical Neuropsychologist in Elkins Park, PA
• Providers in Elkins Park, PA by specialty
• Clinical Neuropsychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2015; 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.