MEDICARE: DR. GAYLE CHESLEY 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	PS016077	PA

General Provider Information

NPI Number	:	1326149030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAYLE CHESLEY PH.D.

Provider Business Mailing Address
First Line	:	3440 MARKET ST
Second Line	:	SUITE 410
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3325
Country	:	US
Telephone Number	:	215-590-7532
Fax Number	:	215-590-4251

Provider Business Practice Location Address
First Line	:	3405 CIVIC CENTER BLVD
Second Line	:	CENTER FOR REHAB
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4302
Country	:	US
Telephone Number	:	215-590-7555
Fax Number	:	215-590-7387

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	03/02/2009

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