Provider Demographics
NPI:1710341128
Name:THUMMEL, STEPHANIE BERYL (LSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BERYL
Last Name:THUMMEL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3530
Mailing Address - Country:US
Mailing Address - Phone:215-510-3097
Mailing Address - Fax:215-456-0184
Practice Address - Street 1:122 W ERIE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-2725
Practice Address - Country:US
Practice Address - Phone:215-510-3097
Practice Address - Fax:215-456-0184
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW122399104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker