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Steve Robert Wysocki

Psychologist

Behavioral Health & Social Service Providers

9089 Baseline Rd Ste 200, Rancho Cucamonga, CA 91730-1295

PECOS Enrollment

This provider is enrolled in PECOS as STEPHEN WYSOCKI.

Based on the most recent information from CMS, provider Steve Robert Wysocki is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1245319276
Provider Type
Individual
Full Name
Wysocki, Steve Robert
Title
Dr.
Credential
PH.D.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
11/2/2006
Last Updated
7/8/2007

Contact Information

Practice Location

9089 Baseline Rd Ste 200, Rancho Cucamonga, CA 91730-1295

(909) 980-3567

(909) 989-3932

Mailing Location

9089 Baseline Rd Ste 200, Rancho Cucamonga, CA 91730-1295

(909) 980-3567

(909) 989-3932

Provider Taxonomies

Code	Description	License
Code 103T00000X Primary	Description Psychologist Behavioral Health & Social Service Providers	License PSY6143 California

Steve Robert Wysocki

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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