| Headway California Behavioral Health Services Pc | |
|
205 Hudson St Fl 9 New York NY 10013-1810 | |
| (646) 453-6777 | |
| (212) 337-9841 |
| Full Name | Headway California Behavioral Health Services Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 205 Hudson St Fl 9, New York, New York |
| Authorized Official Name and Position | Cary Crall (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6464536777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Headway California Behavioral Health Services Pc 205 Hudson St Fl 9 New York NY 10013-1810 Ph: (646) 453-6777 | Headway California Behavioral Health Services Pc 205 Hudson St Fl 9 New York NY 10013-1810 Ph: (646) 453-6777 |
| NPI Number | 1174292866 |
|---|---|
| Provider Enumeration Date | 09/07/2021 |
| Last Update Date | 08/27/2024 |
| Certification Date | 08/27/2024 |
| Medicare PECOS PAC ID | 2769839596 |
|---|---|
| Medicare Enrollment ID | O20231115002684 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174292866 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Veronica B Gardner-mendoza |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235376450 PECOS PAC ID: 6103191150 Enrollment ID: I20171002002230 |
| Provider Name | Mark J Ingram |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1477846160 PECOS PAC ID: 7618148958 Enrollment ID: I20200505001549 |
| Provider Name | Amanda Alonzo |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1386262764 PECOS PAC ID: 5991141277 Enrollment ID: I20240308001297 |
| Provider Name | Anisha Monea Holden |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1629555123 PECOS PAC ID: 1153767447 Enrollment ID: I20240308001927 |
| Provider Name | Leila Evelyn Mccauley |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1144340241 PECOS PAC ID: 2264878412 Enrollment ID: I20240309000652 |
| Provider Name | Monica Flores |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1043559826 PECOS PAC ID: 9234575382 Enrollment ID: I20240311003782 |
| Provider Name | Claudia J Cuevas |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1124203377 PECOS PAC ID: 8729424825 Enrollment ID: I20240312001385 |
| Provider Name | Corrin Elysia Crain |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1972162329 PECOS PAC ID: 7214373331 Enrollment ID: I20240312002056 |
| Provider Name | Martha Lynn Hosier |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1730726407 PECOS PAC ID: 5597101352 Enrollment ID: I20240314003559 |
| Provider Name | Matthew Christian Mendoza |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1659872711 PECOS PAC ID: 3476999244 Enrollment ID: I20240314003767 |
| Provider Name | Amanda Marie Mastrup |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1699026765 PECOS PAC ID: 9133567928 Enrollment ID: I20240328003307 |
| Provider Name | Karissa Lentz |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1184158982 PECOS PAC ID: 0547600298 Enrollment ID: I20240430000014 |
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