MEDICARE: DR. TRICIA ANN WOLANIN PSY.D.

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	103T00000X	Psychologist	68 016897	NY
2	103TC0700X	Clinical Psychologist	22880	CA

General Provider Information

NPI Number	:	1194911024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRICIA ANN WOLANIN PSY.D.

Provider Business Mailing Address
First Line	:	PSC 37 BOX 1332
Second Line	:
City	:	APO
State	:	AE
Zip	:	09459-0014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1145 GAYLEY AVE STE 322
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-3415
Country	:	US
Telephone Number	:	310-481-5246
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	04/27/2018

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