MEDICARE: DR. RUSSELL RICHARD WOESSNER PSY.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	103G00000X	Clinical Neuropsychologist	PS006857L	PA

General Provider Information

NPI Number	:	1689629016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL RICHARD WOESSNER PSY.D.

Provider Business Mailing Address
First Line	:	640 W PHIL ELLENA ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-3523
Country	:	US
Telephone Number	:	215-844-8479
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 WALNUT ST
Second Line	:	SUITE 901
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2944
Country	:	US
Telephone Number	:	215-844-8479
Fax Number	:

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/08/2007

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