Provider Demographics
NPI:1518017805
Name:STERN, IRINA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:S
Last Name:STERN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9892 BUSTLETON AVE
Mailing Address - Street 2:SUITE # 306
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2184
Mailing Address - Country:US
Mailing Address - Phone:267-475-1188
Mailing Address - Fax:215-969-4300
Practice Address - Street 1:9892 BUSTLETON AVE
Practice Address - Street 2:SUITE # 306
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-2184
Practice Address - Country:US
Practice Address - Phone:267-475-1188
Practice Address - Fax:215-969-4300
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-007883-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA851341Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER