=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063707636
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARKWAY PSYCHOTHERAPY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2011
-----------------------------------------------------
Last Update Date | 06/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 BENJAMIN FRANKLIN PKWY W110
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19130-3601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-331-9661
-----------------------------------------------------
Fax | 215-563-2616
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2200 BENJAMIN FRANKLIN PKWY W1914
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19130-3601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-331-9661
-----------------------------------------------------
Fax | 215-563-2616
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR
-----------------------------------------------------
Name | DR. HARRIS W STERN
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 610-331-9661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PS-006075-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------