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4403 Forest Hill Ave Richmond VA 23225-3241 | |
| (848) 210-0028 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 4403 Forest Hill Ave, Richmond, Virginia |
| Authorized Official Name and Position | Levi Lipovenko (CEO) |
| Authorized Official Contact | 8044461710 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
440 Sylvan Ave Ste 240 Englewood Cliffs NJ 07632-2700 Ph: (804) 446-1710 | 4403 Forest Hill Ave Richmond VA 23225-3241 Ph: (848) 210-0028 |
| NPI Number | 1225856008 |
|---|---|
| Provider Enumeration Date | 09/30/2024 |
| Last Update Date | 12/25/2024 |
| Certification Date | 12/25/2024 |
| Medicare PECOS PAC ID | 3274067210 |
|---|---|
| Medicare Enrollment ID | O20241113000945 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225856008 | NPI | - | NPPES |
| Provider Name | Levi Lipovenko |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609352608 PECOS PAC ID: 4082089859 Enrollment ID: I20241113001561 |
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