Healthcare Provider Details

I. General information

NPI: 1154502581
Provider Name (Legal Business Name): TY CULINER, PH.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 N MAIN ST
NEW HOPE PA
18938-1340
US

IV. Provider business mailing address

55 N MAIN ST
NEW HOPE PA
18938-1340
US

V. Phone/Fax

Practice location:
  • Phone: 215-862-6992
  • Fax:
Mailing address:
  • Phone: 215-862-6992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS008396L
License Number StatePA

VIII. Authorized Official

Name: DR. TY CULINER
Title or Position: CHIEF OFFICER
Credential: PH.D.
Phone: 215-862-6992