| Ellie Mental Health | |
|
1503 Santa Rosa Rd Rm 109 Henrico VA 23229-5105 | |
| (804) 822-5660 | |
| Not Available |
| Full Name | Ellie Mental Health |
|---|---|
| Speciality | Social Worker |
| Location | 1503 Santa Rosa Rd Rm 109, Henrico, Virginia |
| Authorized Official Name and Position | Steven Rivera (OWNER) |
| Authorized Official Contact | 8048225660 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Mental Health 3819 Bethesda Ct Chester VA 23831-1347 Ph: (804) 822-5660 | Ellie Mental Health 1503 Santa Rosa Rd Rm 109 Henrico VA 23229-5105 Ph: (804) 822-5660 |
| NPI Number | 1821781865 |
|---|---|
| Provider Enumeration Date | 05/26/2023 |
| Last Update Date | 11/17/2023 |
| Certification Date | 11/17/2023 |
| Medicare PECOS PAC ID | 7416308424 |
|---|---|
| Medicare Enrollment ID | O20240103004116 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821781865 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Alexandra Michelle Bashkoff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033663083 PECOS PAC ID: 1052762069 Enrollment ID: I20240105002330 |
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