MEDICARE: DR. DENISE MARIE VANESSEN PHD

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	PS007779L	PA

General Provider Information

NPI Number	:	1619185279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENISE MARIE VANESSEN PHD

Provider Business Mailing Address
First Line	:	1004 BEECHERSTOWN ROAD
Second Line	:
City	:	BIGLERVILLE
State	:	PA
Zip	:	17307-9102
Country	:	US
Telephone Number	:	717-677-0979
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 EAST MIDDLE STREET
Second Line	:
City	:	GETTYSBURG
State	:	PA
Zip	:	17325-2321
Country	:	US
Telephone Number	:	717-334-0090
Fax Number	:

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/08/2007

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