MEDICARE: KYLE SCHULTZ PSY.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	103TC0700X	Clinical Psychologist	PS017570	PA

General Provider Information

NPI Number	:	1013326438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE SCHULTZ PSY.D.

Provider Business Mailing Address
First Line	:	1420 WALNUT ST STE 1207
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-4012
Country	:	US
Telephone Number	:	267-225-5606
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 WALNUT ST STE 1207
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-4012
Country	:	US
Telephone Number	:	267-225-5606
Fax Number	:

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

Provider Enumeration Date	:	08/11/2014
Last Update Date	:	03/21/2024

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