MEDICARE: DR. RACHAEL D KERNS-WETHERINGTON PSYD

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	5354	NJ
2	103T00000X	Psychologist	PS017558	PA

General Provider Information

NPI Number	:	1770075483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHAEL D KERNS-WETHERINGTON PSYD

Provider Business Mailing Address
First Line	:	1900 E HAROLD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-1108
Country	:	US
Telephone Number	:	612-242-1787
Fax Number	:

Provider Business Practice Location Address
First Line	:	4617 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-3836
Country	:	US
Telephone Number	:	612-242-1787
Fax Number	:

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

Provider Enumeration Date	:	05/30/2018
Last Update Date	:	05/30/2018

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