Provider Demographics
NPI:1962703330
Name:FLEISHER, STACI D (PSYD)
Entity type:Individual
Prefix:DR
First Name:STACI
Middle Name:D
Last Name:FLEISHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10521 DRUMMOND RD
Mailing Address - Street 2:SPIN-BEHAVIORAL AND DEVELOPMENTAL SERVICES
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-3807
Mailing Address - Country:US
Mailing Address - Phone:267-688-4285
Mailing Address - Fax:
Practice Address - Street 1:10521 DRUMMOND RD
Practice Address - Street 2:SPIN-BEHAVIORAL AND DEVELOPMENTAL SERVICES
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-3807
Practice Address - Country:US
Practice Address - Phone:267-688-4285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016905103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical