MEDICARE: PARKWAY PSYCHOTHERAPY ASSOCIATES

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	103T00000X	Psychologist	PS-006075-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11654945	OTHER	PA	CAQH

General Provider Information

NPI Number	:	1063707636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKWAY PSYCHOTHERAPY ASSOCIATES

Provider Business Mailing Address
First Line	:	2200 BENJAMIN FRANKLIN PKWY
Second Line	:	W1914
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3601
Country	:	US
Telephone Number	:	610-331-9661
Fax Number	:	215-563-2616

Provider Business Practice Location Address
First Line	:	2200 BENJAMIN FRANKLIN PKWY
Second Line	:	W110
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3601
Country	:	US
Telephone Number	:	610-331-9661
Fax Number	:	215-563-2616

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	DR. HARRIS W STERN
Credential	:	PH.D.
Telephone Number	:	610-331-9661

Provider Enumeration Date	:	06/12/2011
Last Update Date	:	06/12/2011

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Directions to “PARKWAY PSYCHOTHERAPY ASSOCIATES ” Practice Location

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