MEDICARE: HARRIS W STERN PHD

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	PS006075L	PA

General Provider Information

NPI Number	:	1649271719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRIS W STERN PHD

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	:	E105
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3601
Country	:	US
Telephone Number	:	610-331-9661
Fax Number	:	215-563-2616

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	12/09/2011

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