Provider Demographics
NPI:1710484779
Name:WAKEMAN, STEFANIE (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:WAKEMAN
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:
Other - Last Name:ESHLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:2525 MEREDITH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2421
Mailing Address - Country:US
Mailing Address - Phone:267-973-5453
Mailing Address - Fax:
Practice Address - Street 1:1505 RACE ST FL 6
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1119
Practice Address - Country:US
Practice Address - Phone:215-762-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW122600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker