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STACEY CARPENTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PSY.D.

Contact information

Practice address
850 N 11TH ST, PHILADELPHIA, PA 19123-1957
(215) 769-1103
(215) 769-1118
Mailing address
4700 WISSAHICKON AVE, STE 118 BLGD D, PHILADELPHIA, PA 19144-4248
(215) 843-2580

Taxonomy

Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PS017189
PA

Other

Enumeration date
09/19/2012
Last updated
09/19/2012
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