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General NPI Number Information
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NPI Number | 1831963743
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Entity Type | Individual
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Provider Name | SALLY MICHELLE STIEFEL PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/10/2023
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Last Update Date | 11/10/2023
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Provider Practice Location Address
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Address Line | 3535 MARKET ST FL 2
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3317
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Country | US
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Telephone | 215-746-6701
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Fax |
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Provider Business Mailing Address
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Address Line | 1737 CHESTNUT ST APT 901
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City | PHILADELPHIA
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State | PA
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Zip | 19103-4107
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Country | US
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Telephone | 215-908-3355
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS020016
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License Number State | PA
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