MEDICARE: KEVIN KUEHLWEIN 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	PS006142L	PA

General Provider Information

NPI Number	:	1871523944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN KUEHLWEIN PSYD

Provider Business Mailing Address
First Line	:	1616 WALNUT ST
Second Line	:	SUITE 1120
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-5313
Country	:	US
Telephone Number	:	215-551-1488
Fax Number	:	215-898-1865

Provider Business Practice Location Address
First Line	:	1616 WALNUT ST
Second Line	:	SUITE 1120
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-5313
Country	:	US
Telephone Number	:	215-551-1488
Fax Number	:	215-898-1865

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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