Provider Demographics
NPI:1144765504
Name:STOKES, JEANNA ALICIA (PSYD)
Entity Type:Individual
Prefix:
First Name:JEANNA
Middle Name:ALICIA
Last Name:STOKES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 RACE ST UNIT 406
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1081
Mailing Address - Country:US
Mailing Address - Phone:312-718-2815
Mailing Address - Fax:
Practice Address - Street 1:2323 RACE ST UNIT 406
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1081
Practice Address - Country:US
Practice Address - Phone:312-718-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05884103TC0700X
PAPS018750103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical