Provider Demographics
NPI:1649271719
Name:STERN, HARRIS W (PHD)
Entity type:Individual
Prefix:
First Name:HARRIS
Middle Name:W
Last Name:STERN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 BENJAMIN FRANKLIN PKWY
Mailing Address - Street 2:W1914
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3601
Mailing Address - Country:US
Mailing Address - Phone:610-331-9661
Mailing Address - Fax:215-563-2616
Practice Address - Street 1:2200 BENJAMIN FRANKLIN PKWY
Practice Address - Street 2:E105
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3601
Practice Address - Country:US
Practice Address - Phone:610-331-9661
Practice Address - Fax:215-563-2616
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006075L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S71204Medicare UPIN
PA147228HFHMedicare ID - Type Unspecified