Provider Demographics
NPI:1780925370
Name:STERN, REBECCA (PSYD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:STERN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6814 QUINCY ST
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2670
Mailing Address - Country:US
Mailing Address - Phone:919-618-1154
Mailing Address - Fax:
Practice Address - Street 1:6814 QUINCY ST
Practice Address - Street 2:SUITE 1F
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2670
Practice Address - Country:US
Practice Address - Phone:919-618-1154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017315103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist