MEDICARE: DR. CAROL J TADEUSIK 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	1544	NC

General Provider Information

NPI Number	:	1679663421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL J TADEUSIK PH.D.

Provider Business Mailing Address
First Line	:	3622 LYCKAN PKWY
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-2564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3622 LYCKAN PKWY
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-2564
Country	:	US
Telephone Number	:	919-489-3151
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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