Provider Demographics
NPI:1326696535
Name:FLEMING, PHYLICIA F (PHD, NCSP)
Entity type:Individual
Prefix:
First Name:PHYLICIA
Middle Name:F
Last Name:FLEMING
Suffix:
Gender:
Credentials:PHD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 SOUTH ST # 8322
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2305
Mailing Address - Country:US
Mailing Address - Phone:601-291-9504
Mailing Address - Fax:
Practice Address - Street 1:4601 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-4636
Practice Address - Country:US
Practice Address - Phone:215-590-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024047158103T00000X
PAPS019763103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist