Provider Demographics
NPI:1093752560
Name:WILNER, KARYNE BETH (PSYD)
Entity Type:Individual
Prefix:
First Name:KARYNE
Middle Name:BETH
Last Name:WILNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:BETH
Other - Last Name:MILLER GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:49 EMELINE STREET
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906
Mailing Address - Country:US
Mailing Address - Phone:401-274-3512
Mailing Address - Fax:401-751-8997
Practice Address - Street 1:1601 WALNUT STREET
Practice Address - Street 2:SUITE 1017 MEDICAL ARTS BLDG
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102
Practice Address - Country:US
Practice Address - Phone:215-665-0705
Practice Address - Fax:401-751-8997
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS0045841L103TC0700X
RIPS00923103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWI421649Medicare ID - Type Unspecified