| A New Leaf Psychotherapy Llc | |
|
10552 Success Ln Ste C Dayton OH 45458-3664 | |
| (937) 507-6520 | |
| (937) 889-2895 |
| Full Name | A New Leaf Psychotherapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 10552 Success Ln Ste C, Dayton, Ohio |
| Authorized Official Name and Position | Megan Pera (SOLE MEMBER) |
| Authorized Official Contact | 9375076520 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A New Leaf Psychotherapy Llc Po Box 596 Monroe OH 45050-0596 Ph: (937) 507-6520 | A New Leaf Psychotherapy Llc 10552 Success Ln Ste C Dayton OH 45458-3664 Ph: (937) 507-6520 |
| NPI Number | 1326646266 |
|---|---|
| Provider Enumeration Date | 10/13/2020 |
| Last Update Date | 01/25/2021 |
| Certification Date | 01/25/2021 |
| Medicare PECOS PAC ID | 1658781877 |
|---|---|
| Medicare Enrollment ID | O20201029000657 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326646266 | NPI | - | NPPES |
| 0424435 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Megan A Pera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760574842 PECOS PAC ID: 6204925100 Enrollment ID: I20170418000513 |
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