| Clearwater Emdr Llc | |
|
2430 Estancia Blvd Ste 100a Clearwater FL 33761-2644 | |
| (727) 316-5740 | |
| (833) 216-5165 |
| Full Name | Clearwater Emdr Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2430 Estancia Blvd Ste 100a, Clearwater, Florida |
| Authorized Official Name and Position | Marie Vagedes (OWNER) |
| Authorized Official Contact | 7273165740 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clearwater Emdr Llc 2430 Estancia Blvd Ste 100a Clearwater FL 33761-2644 Ph: (727) 316-5740 | Clearwater Emdr Llc 2430 Estancia Blvd Ste 100a Clearwater FL 33761-2644 Ph: (727) 316-5740 |
| NPI Number | 1417619446 |
|---|---|
| Provider Enumeration Date | 10/07/2021 |
| Last Update Date | 10/07/2021 |
| Certification Date | 10/07/2021 |
| Medicare PECOS PAC ID | 9133508765 |
|---|---|
| Medicare Enrollment ID | O20220628001033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417619446 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Marie A Vagedes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740470236 PECOS PAC ID: 3971781717 Enrollment ID: I20131017000466 |
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