| Jacob Rusczek Phd Pllc | |
|
301 River St Ste 204 Montpelier VT 05602-4327 | |
| (802) 505-5026 | |
| Not Available |
| Full Name | Jacob Rusczek Phd Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 301 River St Ste 204, Montpelier, Vermont |
| Authorized Official Name and Position | Jacob Robert Rusczek (OWNER) |
| Authorized Official Contact | 8025055026 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacob Rusczek Phd Pllc 301 River St Ste 204 Montpelier VT 05602-4327 Ph: (802) 505-5026 | Jacob Rusczek Phd Pllc 301 River St Ste 204 Montpelier VT 05602-4327 Ph: (802) 505-5026 |
| NPI Number | 1114796489 |
|---|---|
| Provider Enumeration Date | 12/27/2023 |
| Last Update Date | 12/27/2023 |
| Certification Date | 12/27/2023 |
| Medicare PECOS PAC ID | 5597109686 |
|---|---|
| Medicare Enrollment ID | O20240216001324 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114796489 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jacob Robert Rusczek |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932622461 PECOS PAC ID: 0345513651 Enrollment ID: I20170908001364 |
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