| Ascending Psychotherapy-pw Lcsw Pc | |
|
14722 Village Rd Apt 82b Jamaica NY 11435-6307 | |
| (917) 224-5793 | |
| Not Available |
| Full Name | Ascending Psychotherapy-pw Lcsw Pc |
|---|---|
| Speciality | Social Worker |
| Location | 14722 Village Rd Apt 82b, Jamaica, New York |
| Authorized Official Name and Position | Pamela Wallace (OWNER) |
| Authorized Official Contact | 9172245793 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ascending Psychotherapy-pw Lcsw Pc 14722 Village Rd Apt 82b Jamaica NY 11435-6307 Ph: (917) 224-5793 | Ascending Psychotherapy-pw Lcsw Pc 14722 Village Rd Apt 82b Jamaica NY 11435-6307 Ph: (917) 224-5793 |
| NPI Number | 1427563014 |
|---|---|
| Provider Enumeration Date | 12/05/2017 |
| Last Update Date | 03/17/2018 |
| Medicare PECOS PAC ID | 7517205818 |
|---|---|
| Medicare Enrollment ID | O20190212001990 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427563014 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 075520 (New York) | Primary |
| Provider Name | Pamela Wallace |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457493900 PECOS PAC ID: 3173702305 Enrollment ID: I20110120000482 |
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