| Beacon Psychotherapy Services, Llc | |
|
3640 S Plaza Trl Ste 103d Virginia Beach VA 23452-3363 | |
| (757) 818-4542 | |
| (757) 299-3031 |
| Full Name | Beacon Psychotherapy Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 3640 S Plaza Trl Ste 103d, Virginia Beach, Virginia |
| Authorized Official Name and Position | Fredric Harvey Bricka (OWNER/CLINICIAN) |
| Authorized Official Contact | 7578184542 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beacon Psychotherapy Services, Llc 3640 S Plaza Trl Ste 103d Virginia Beach VA 23452-3363 Ph: (757) 818-4542 | Beacon Psychotherapy Services, Llc 3640 S Plaza Trl Ste 103d Virginia Beach VA 23452-3363 Ph: (757) 818-4542 |
| NPI Number | 1972016376 |
|---|---|
| Provider Enumeration Date | 11/08/2017 |
| Last Update Date | 11/13/2017 |
| Medicare PECOS PAC ID | 2567728207 |
|---|---|
| Medicare Enrollment ID | O20171113001616 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972016376 | NPI | - | NPPES |
| 010142768 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Fredric Harvey Bricka |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770565442 PECOS PAC ID: 7911948237 Enrollment ID: I20050517000957 |
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