| Changing Patterns Psychotherapy Services, Llc | |
|
420 Chinquapin Round Rd Ste 2i Annapolis MD 21401-4006 | |
| (443) 261-5950 | |
| Not Available |
| Full Name | Changing Patterns Psychotherapy Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 420 Chinquapin Round Rd Ste 2i, Annapolis, Maryland |
| Authorized Official Name and Position | Kerry Ellis (OWNER) |
| Authorized Official Contact | 4432615950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Changing Patterns Psychotherapy Services, Llc 420 Chinquapin Round Rd Ste 2i Annapolis MD 21401-4006 Ph: (443) 261-5950 | Changing Patterns Psychotherapy Services, Llc 420 Chinquapin Round Rd Ste 2i Annapolis MD 21401-4006 Ph: (443) 261-5950 |
| NPI Number | 1134893522 |
|---|---|
| Provider Enumeration Date | 08/09/2021 |
| Last Update Date | 08/09/2021 |
| Certification Date | 08/09/2021 |
| Medicare PECOS PAC ID | 6204214562 |
|---|---|
| Medicare Enrollment ID | O20220528000004 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134893522 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kerry A Ellis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134631757 PECOS PAC ID: 6305101528 Enrollment ID: I20180517001310 |
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