| Betsy Pedersen Phd Pc | |
|
1502 W Nc Highway 54 Suite 603 Durham NC 27707-5571 | |
| (919) 923-3278 | |
| (919) 419-3110 |
| Full Name | Betsy Pedersen Phd Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1502 W Nc Highway 54, Durham, North Carolina |
| Authorized Official Name and Position | Elizabeth R Pedersen (PRESIDENT) |
| Authorized Official Contact | 9199233278 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Betsy Pedersen Phd Pc 1502 W Nc Highway 54 Suite 603 Durham NC 27707-5571 Ph: (919) 923-3278 | Betsy Pedersen Phd Pc 1502 W Nc Highway 54 Suite 603 Durham NC 27707-5571 Ph: (919) 923-3278 |
| NPI Number | 1346665882 |
|---|---|
| Provider Enumeration Date | 02/20/2014 |
| Last Update Date | 02/20/2014 |
| Medicare PECOS PAC ID | 4486943446 |
|---|---|
| Medicare Enrollment ID | O20160513000968 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346665882 | NPI | - | NPPES |
| 2815321B | Other | NC | MEDICARE PTAN |
| 1808 | Other | NC | PRACTICE LICENSE -PSYCHOLOGIST |
| 60008531D | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 1808 (North Carolina) | Primary |
| Provider Name | Elizabeth Rose Pedersen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588634125 PECOS PAC ID: 2264523844 Enrollment ID: I20070810000657 |
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