MEDICARE: DR. TY CULINER 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	103T00000X	Psychologist	PS-008396-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CU400592	OTHER		BLUE CROSS BLUE SHIELD PP

General Provider Information

NPI Number	:	1154315927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TY CULINER PH.D.

Provider Business Mailing Address
First Line	:	55 NORTH MAIN STREET
Second Line	:
City	:	NEW HOPE
State	:	PA
Zip	:	18938-1340
Country	:	US
Telephone Number	:	215-862-6992
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 N MAIN ST
Second Line	:
City	:	NEW HOPE
State	:	PA
Zip	:	18938-1340
Country	:	US
Telephone Number	:	215-862-6992
Fax Number	:

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	11/13/2007

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