MEDICARE: JOELY ESPOSITO PSYD

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	PS008878L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS008878L	OTHER	PA	PA STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1740354737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOELY ESPOSITO PSYD

Provider Business Mailing Address
First Line	:	PO BOX 359
Second Line	:
City	:	FURLONG
State	:	PA
Zip	:	18925-0359
Country	:	US
Telephone Number	:	215-735-2505
Fax Number	:	215-735-2504

Provider Business Practice Location Address
First Line	:	1528 WALNUT ST
Second Line	:	SUITE 1500
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3604
Country	:	US
Telephone Number	:	215-735-2505
Fax Number	:	215-735-2504

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	09/14/2009

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Directions to “ JOELY ESPOSITO PSYD” Practice Location

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