MEDICARE: DR. WILLIAM C CULBERTSON 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	1747	NJ

General Provider Information

NPI Number	:	1750596821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM C CULBERTSON PSY.D.

Provider Business Mailing Address
First Line	:	216 HADDON AVE
Second Line	:	SUITE 601
City	:	HADDON TOWNSHIP
State	:	NJ
Zip	:	08108-2809
Country	:	US
Telephone Number	:	856-833-1993
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 HADDON AVE
Second Line	:	SUITE 601
City	:	HADDON TOWNSHIP
State	:	NJ
Zip	:	08108-2809
Country	:	US
Telephone Number	:	856-833-1993
Fax Number	:

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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