MEDICARE: AURELIE WELTERLIN PSYD, BCBA-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	103TC0700X	Clinical Psychologist	102873	NC
2	103K00000X	Behavior Analyst	1084238	NJ

General Provider Information

NPI Number	:	1891024634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AURELIE WELTERLIN PSYD, BCBA-D

Provider Business Mailing Address
First Line	:	3209 YORKTOWN AVE
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-3454
Country	:	US
Telephone Number	:	919-213-9845
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 NW MAYNARD RD STE 140
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-8707
Country	:	US
Telephone Number	:	919-428-2766
Fax Number	:

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

Provider Enumeration Date	:	12/07/2009
Last Update Date	:	10/06/2013

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