MEDICARE: DR. ERICA MARLA SCHULTE PHD

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	PS019147	PA

General Provider Information

NPI Number	:	1447851092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICA MARLA SCHULTE PHD

Provider Business Mailing Address
First Line	:	609 N BODINE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-2912
Country	:	US
Telephone Number	:	913-653-5022
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 MARKET ST STE 3032
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3313
Country	:	US
Telephone Number	:	913-653-5022
Fax Number	:

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

Provider Enumeration Date	:	11/02/2020
Last Update Date	:	11/02/2020

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