| Jewish Family Service Of Tidewater, Incorporated | |
|
260 Grayson Rd Ste 200 Virginia Beach VA 23462-4345 | |
| (757) 459-4640 | |
| (757) 459-4643 |
| Full Name | Jewish Family Service Of Tidewater, Incorporated |
|---|---|
| Speciality | Social Worker |
| Location | 260 Grayson Rd Ste 200, Virginia Beach, Virginia |
| Authorized Official Name and Position | Debra Friedman Mayer (CLINICAL DIRECTOR) |
| Authorized Official Contact | 7574594640 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jewish Family Service Of Tidewater, Incorporated 5000 Corporate Woods Dr Ste 400 Virginia Beach VA 23462-4429 Ph: (757) 459-4640 | Jewish Family Service Of Tidewater, Incorporated 260 Grayson Rd Ste 200 Virginia Beach VA 23462-4345 Ph: (757) 459-4640 |
| NPI Number | 1124088638 |
|---|---|
| Provider Enumeration Date | 03/27/2006 |
| Last Update Date | 04/07/2023 |
| Certification Date | 04/07/2023 |
| Medicare PECOS PAC ID | 2365356169 |
|---|---|
| Medicare Enrollment ID | O20040816001334 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124088638 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Debra F Mayer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699735308 PECOS PAC ID: 2668432402 Enrollment ID: I20041015000180 |
| Provider Name | Michelle Marley Fenley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154356640 PECOS PAC ID: 9436181039 Enrollment ID: I20050902000696 |
| Provider Name | Dennis D Patterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629063805 PECOS PAC ID: 1456425263 Enrollment ID: I20080728000538 |
| Provider Name | Michelle Joan Walter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043236060 PECOS PAC ID: 6103957279 Enrollment ID: I20100706000768 |
| Provider Name | Arnold Unterbach |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598813883 PECOS PAC ID: 4284731134 Enrollment ID: I20101019000747 |
| Provider Name | Carolyn Susan Lempert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902333081 PECOS PAC ID: 1052681152 Enrollment ID: I20170724000390 |
| Provider Name | Emily Lucetta Joan Bettendorf Riley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861023012 PECOS PAC ID: 4183055940 Enrollment ID: I20200511002004 |
| Provider Name | Maya Leigh Ball |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265132864 PECOS PAC ID: 7810352051 Enrollment ID: I20230424000702 |
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