Individual
STACEY A SUMMERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1601 WALNUT ST STE 1017, PHILADELPHIA, PA 19102-2906
(215) 564-0488
(215) 564-1245
Mailing address
1601 WALNUT ST STE 1017, PHILADELPHIA, PA 19102-2906
(215) 564-0488
(215) 564-1245
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS015838
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1017489680001
—
PA
Enumeration date
11/29/2007
Last updated
02/18/2021
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