MEDICARE: DR. JANET L ETZI PSYD

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	PS005770L	PA

General Provider Information

NPI Number	:	1124113873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANET L ETZI PSYD

Provider Business Mailing Address
First Line	:	18 DRUIM MOIR LN
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-4134
Country	:	US
Telephone Number	:	215-264-4625
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 DRUIM MOIR LN
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-4134
Country	:	US
Telephone Number	:	215-264-4625
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	08/31/2013

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