MEDICARE: DR. VINCENT J NERVIANO PH.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	PS005722L	PA
2	103TC0700X	Clinical Psychologist	PS005722L	PA
3	103TC1900X	Counseling Psychologist	PS005722L	PA
4	103TC2200X	Clinical Child & Adolescent Psychologist	PS005722L	PA

General Provider Information

NPI Number	:	1932108420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT J NERVIANO PH.D.

Provider Business Mailing Address
First Line	:	2660 VERANDAH LN
Second Line	:	APT 316
City	:	ARLINGTON
State	:	TX
Zip	:	76006-3207
Country	:	US
Telephone Number	:	717-579-2349
Fax Number	:

Provider Business Practice Location Address
First Line	:	2660 VERANDAH LN
Second Line	:	APT 316
City	:	ARLINGTON
State	:	TX
Zip	:	76006-3207
Country	:	US
Telephone Number	:	717-579-2349
Fax Number	:

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	05/06/2014

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