Provider Demographics
NPI:1013116870
Name:STIMMELL, SUSAN MARY (LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:STIMMELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 CALLOWHILL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-4109
Mailing Address - Country:US
Mailing Address - Phone:215-496-0707
Mailing Address - Fax:215-627-9042
Practice Address - Street 1:1823 CALLOWHILL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-4109
Practice Address - Country:US
Practice Address - Phone:215-496-0707
Practice Address - Fax:215-627-9042
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004151101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional