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509 Broad St Ste C New Bern NC 28560-4803 | |
| (805) 418-0456 | |
| (252) 649-2786 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 509 Broad St Ste C, New Bern, North Carolina |
| Authorized Official Name and Position | Casey Richardson (OWNER) |
| Authorized Official Contact | 8054180456 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1140 Amberjack Ct New Bern NC 28562-1019 Ph: (805) 418-0456 | 509 Broad St Ste C New Bern NC 28560-4803 Ph: (805) 418-0456 |
| NPI Number | 1275223950 |
|---|---|
| Provider Enumeration Date | 05/08/2023 |
| Last Update Date | 01/21/2025 |
| Certification Date | 01/21/2025 |
| Medicare PECOS PAC ID | 7719324797 |
|---|---|
| Medicare Enrollment ID | O20240326003081 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275223950 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Casey Richardson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972928174 PECOS PAC ID: 6608245048 Enrollment ID: I20221207001979 |
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