MEDICARE: DR. YVONNE ROBERTA WOOD-ANTONUCCIO 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	103TC0700X	Clinical Psychologist	PY116	NV

General Provider Information

NPI Number	:	1043317480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YVONNE ROBERTA WOOD-ANTONUCCIO PH.D.

Provider Business Mailing Address
First Line	:	4730 ABERFELDY RD
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89519-0943
Country	:	US
Telephone Number	:	775-329-3393
Fax Number	:	775-827-6233

Provider Business Practice Location Address
First Line	:	3732 LAKESIDE DR
Second Line	:	STE. 200
City	:	RENO
State	:	NV
Zip	:	89509-5238
Country	:	US
Telephone Number	:	775-329-3393
Fax Number	:	775-827-4799

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	11/10/2008

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