| Eastern Door Licensed Clinical Social Work, Pc | |
|
620 Washington Ave Rensselaer NY 12144-1300 | |
| (518) 252-7073 | |
| (518) 252-7073 |
| Full Name | Eastern Door Licensed Clinical Social Work, Pc |
|---|---|
| Speciality | Social Worker |
| Location | 620 Washington Ave, Rensselaer, New York |
| Authorized Official Name and Position | Kellyanne Rugenstein (OWNER) |
| Authorized Official Contact | 5182527073 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastern Door Licensed Clinical Social Work, Pc 620 Washington Ave Rensselaer NY 12144-1300 Ph: (518) 252-7073 | Eastern Door Licensed Clinical Social Work, Pc 620 Washington Ave Rensselaer NY 12144-1300 Ph: (518) 252-7073 |
| NPI Number | 1528500337 |
|---|---|
| Provider Enumeration Date | 11/10/2016 |
| Last Update Date | 07/26/2024 |
| Medicare PECOS PAC ID | 7810278876 |
|---|---|
| Medicare Enrollment ID | O20170105000954 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528500337 | NPI | - | NPPES |
| 03068682 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Kellyanne Rugenstein |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447363015 PECOS PAC ID: 3476528258 Enrollment ID: I20040826000960 |
St. Peters Health Partners Medical Associates Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 279 Troy Rd, Rensselaer, NY 12144 Phone: 518-694-3053 Fax: 518-694-3056 | |
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