MEDICARE: TY CULINER, PH.D. LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS008396L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0244068000	OTHER	PA	INDEPENDENCE BCBS
2	CU400592	OTHER		HIGHMARKBCBS

General Provider Information

NPI Number	:	1154502581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TY CULINER, PH.D. LLC

Provider Business Mailing Address
First Line	:	55 N MAIN ST
Second Line	:
City	:	NEW HOPE
State	:	PA
Zip	:	18938-1340
Country	:	US
Telephone Number	:	215-862-6992
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 N MAIN ST
Second Line	:
City	:	NEW HOPE
State	:	PA
Zip	:	18938-1340
Country	:	US
Telephone Number	:	215-862-6992
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OFFICER
Name	:	DR. TY CULINER
Credential	:	PH.D.
Telephone Number	:	215-862-6992

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	11/14/2007

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