MEDICARE: PAUL WULKAN PSY D LLSW

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	1041C0700X	Clinical Social Worker	LCSW C-676	NV

General Provider Information

NPI Number	:	1700887817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL WULKAN PSY D LLSW

Provider Business Mailing Address
First Line	:	222 S RAINBOW BLVD
Second Line	:	STE 210
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5340
Country	:	US
Telephone Number	:	702-243-4357
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 S RAINBOW BLVD
Second Line	:	STE 210
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5340
Country	:	US
Telephone Number	:	702-243-4357
Fax Number	:

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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