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General NPI Number Information
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NPI Number | 1578813366
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Entity Type | Individual
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Provider Name | STACEY CARPENTER PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 850 N 11TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19123-1957
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Country | US
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Telephone | 215-769-1103
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Fax | 215-769-1118
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Provider Business Mailing Address
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Address Line | 4700 WISSAHICKON AVE STE 118 BLGD D
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City | PHILADELPHIA
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State | PA
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Zip | 19144-4248
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Country | US
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Telephone | 215-843-2580
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS017189
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License Number State | PA
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