MEDICARE: IZABELA MILANIAK 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	103TC0700X	Clinical Psychologist	PS019431	PA
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1952065344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IZABELA MILANIAK PHD

Provider Business Mailing Address
First Line	:	1927 CHRISTIAN ST APT A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1869
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4601 MARKET ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-4636
Country	:	US
Telephone Number	:	215-590-7555
Fax Number	:

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

Provider Enumeration Date	:	10/22/2021
Last Update Date	:	01/29/2025

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