Provider Demographics
NPI:1831963743
Name:STIEFEL, SALLY MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:MICHELLE
Last Name:STIEFEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SALLY
Other - Middle Name:MICHELLE
Other - Last Name:MINKOVICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1737 CHESTNUT ST APT 901
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4107
Mailing Address - Country:US
Mailing Address - Phone:215-908-3355
Mailing Address - Fax:
Practice Address - Street 1:3535 MARKET ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3317
Practice Address - Country:US
Practice Address - Phone:215-746-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS020016103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical