| Gramercy Specialty Clinic Pllc | |
|
4009 Banister Ln Ste 355 Austin TX 78704-7040 | |
| (512) 777-2686 | |
| Not Available |
| Full Name | Gramercy Specialty Clinic Pllc |
|---|---|
| Speciality | Counselor |
| Location | 4009 Banister Ln Ste 355, Austin, Texas |
| Authorized Official Name and Position | Elizabeth Alegria (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5127772686 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gramercy Specialty Clinic Pllc 4009 Banister Ln Ste 355 Austin TX 78704-7040 Ph: (512) 777-2686 | Gramercy Specialty Clinic Pllc 4009 Banister Ln Ste 355 Austin TX 78704-7040 Ph: (512) 777-2686 |
| NPI Number | 1922419324 |
|---|---|
| Provider Enumeration Date | 05/20/2014 |
| Last Update Date | 01/11/2024 |
| Certification Date | 01/11/2024 |
| Medicare PECOS PAC ID | 6709105901 |
|---|---|
| Medicare Enrollment ID | O20150511001716 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922419324 | NPI | - | NPPES |
| Provider Name | Asif M Siddiqui |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407975584 PECOS PAC ID: 9133119852 Enrollment ID: I20040514000776 |
| Provider Name | Amanda T De Leon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588135669 PECOS PAC ID: 5597116046 Enrollment ID: I20240109001831 |
| Provider Name | Maribelle Lock |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285296749 PECOS PAC ID: 6204270069 Enrollment ID: I20240220002818 |
| Provider Name | Emmanuel Rivera |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467020222 PECOS PAC ID: 8628413614 Enrollment ID: I20240229001968 |
| Provider Name | Margarita Y Medina |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649523002 PECOS PAC ID: 4587009204 Enrollment ID: I20240304001591 |
| Provider Name | Leticia Adams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578218293 PECOS PAC ID: 6103267281 Enrollment ID: I20240508000523 |
| Provider Name | Elizabeth Alegria |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740569540 PECOS PAC ID: 1355663147 Enrollment ID: I20240521003532 |
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