Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | OC010224 | PA |
NPI | 1043684988 |
---|---|
Provider Name | Stacey Saleff |
First Address | Phila, PA 19131-1625 |
Second Address | Phila, PA 19131-1625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2015 |
Last Update Date | 16/11/2015 |