MEDICARE: SUSAN MARY STIMMELL L.P.C.

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	101YP2500X	Professional Counselor	PC004151	PA

General Provider Information

NPI Number	:	1013116870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARY STIMMELL L.P.C.

Provider Business Mailing Address
First Line	:	1823 CALLOWHILL ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-4109
Country	:	US
Telephone Number	:	215-496-0707
Fax Number	:	215-627-9042

Provider Business Practice Location Address
First Line	:	1823 CALLOWHILL ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-4109
Country	:	US
Telephone Number	:	215-496-0707
Fax Number	:	215-627-9042

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

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/12/2007

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