Provider Demographics
NPI:1710920095
Name:STILLWATER, ARLENE G (PSYD RN CS)
Entity Type:Individual
Prefix:DR
First Name:ARLENE
Middle Name:G
Last Name:STILLWATER
Suffix:
Gender:F
Credentials:PSYD RN CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 E MT AIRY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119
Mailing Address - Country:US
Mailing Address - Phone:215-248-6700
Mailing Address - Fax:215-248-3594
Practice Address - Street 1:27 E MT AIRY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119
Practice Address - Country:US
Practice Address - Phone:215-248-6700
Practice Address - Fax:215-248-3594
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009051L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
041272FG8Medicare PIN