MEDICARE: JULIA VAYNER 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	103TC0700X	Clinical Psychologist	PS019148	PA

General Provider Information

NPI Number	:	1932773538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA VAYNER PSYD

Provider Business Mailing Address
First Line	:	116 GRENVILLE CIR
Second Line	:
City	:	SOUTHAMPTON
State	:	PA
Zip	:	18966-1550
Country	:	US
Telephone Number	:	267-304-5055
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 CHESTNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4103
Country	:	US
Telephone Number	:	215-665-8670
Fax Number	:

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

Provider Enumeration Date	:	05/18/2021
Last Update Date	:	05/18/2021

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