Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | PS016344 | PA |
NPI | 1073747218 |
---|---|
Provider Name | Shannon Wiltsey Stirman |
First Address | Philadelphia, PA 19147-3736 |
Second Address | Philadelphia, PA 19147-3736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2009 |
Last Update Date | 02/05/2009 |