| Etheridge Psychology, P.a. | |
|
115 Kildaire Park Dr Ste 313 Cary NC 27518-8144 | |
| (919) 600-4906 | |
| (888) 887-6361 |
| Full Name | Etheridge Psychology, P.a. |
|---|---|
| Speciality | Psychologist |
| Location | 115 Kildaire Park Dr Ste 313, Cary, North Carolina |
| Authorized Official Name and Position | Mary Anne Etheridge (PRESIDENT) |
| Authorized Official Contact | 9196004906 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Etheridge Psychology, P.a. 115 Kildaire Park Dr Ste 313 Cary NC 27518-8144 Ph: (919) 600-4906 | Etheridge Psychology, P.a. 115 Kildaire Park Dr Ste 313 Cary NC 27518-8144 Ph: (919) 600-4906 |
| NPI Number | 1275820144 |
|---|---|
| Provider Enumeration Date | 06/29/2011 |
| Last Update Date | 01/24/2020 |
| Certification Date | 01/24/2020 |
| Medicare PECOS PAC ID | 0446406649 |
|---|---|
| Medicare Enrollment ID | O20120803000032 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275820144 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 3686 (North Carolina) | Primary |
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| Provider Name | Mary Anne Etheridge |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437294212 PECOS PAC ID: 8527214725 Enrollment ID: I20120803000080 |
| Provider Name | Roy Lee Etheridge |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215232434 PECOS PAC ID: 2163678368 Enrollment ID: I20120803000123 |
| Provider Name | Courtney M Cantrell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548428162 PECOS PAC ID: 1355483306 Enrollment ID: I20221120000062 |
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