MEDICARE: MRS. ALICELYN WATSON SLEBER MPSSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS007199L	PA

General Provider Information

NPI Number	:	1548362080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALICELYN WATSON SLEBER MPSSC

Provider Business Mailing Address
First Line	:	2626 N 3RD ST
Second Line	:	SUITE 3B
City	:	HARRISBURG
State	:	PA
Zip	:	17110-2044
Country	:	US
Telephone Number	:	717-238-0885
Fax Number	:	717-236-6633

Provider Business Practice Location Address
First Line	:	2626 N 3RD ST
Second Line	:	SUITE 3B
City	:	HARRISBURG
State	:	PA
Zip	:	17110-2044
Country	:	US
Telephone Number	:	717-238-0885
Fax Number	:	717-236-6633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2006
Last Update Date	:	07/08/2007

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