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NPI Code Detail

MEDICARE: DR. MICHELE TERESA SMYK-STROM PH.D.

MEDICARE: DR. MICHELE TERESA SMYK-STROM PH.D.
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
1103T00000XPsychologistPS016370PA

General Provider Information

NPI Number : 1841439783
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHELE TERESA SMYK-STROM PH.D.
Provider Business Mailing Address
First Line : 2900 SOUTHAMPTON RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19154-1202
Country : US
Telephone Number : 215-671-5288
Fax Number : 215-671-7581
Provider Business Practice Location Address
First Line : 2900 SOUTHAMPTON RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19154-1202
Country : US
Telephone Number : 215-671-5288
Fax Number : 215-671-7581
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2009
Last Update Date : 02/17/2009

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