Provider Demographics
NPI:1841439783
Name:SMYK-STROM, MICHELE TERESA (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:TERESA
Last Name:SMYK-STROM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 SOUTHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1202
Mailing Address - Country:US
Mailing Address - Phone:215-671-5288
Mailing Address - Fax:215-671-7581
Practice Address - Street 1:2900 SOUTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1202
Practice Address - Country:US
Practice Address - Phone:215-671-5288
Practice Address - Fax:215-671-7581
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016370103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist