| Keri Mica Lcsw Pc | |
|
176 N Village Ave Suite 2e Rockville Centre NY 11570-3800 | |
| (516) 410-7138 | |
| (516) 679-0736 |
| Full Name | Keri Mica Lcsw Pc |
|---|---|
| Speciality | Social Worker |
| Location | 176 N Village Ave, Rockville Centre, New York |
| Authorized Official Name and Position | Keri Lynn Mica-suttmiller (PRESIDENT) |
| Authorized Official Contact | 5164107138 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Keri Mica Lcsw Pc 111 Hart Street Lynbrook NY 11563-1760 Ph: (516) 410-7138 | Keri Mica Lcsw Pc 176 N Village Ave Suite 2e Rockville Centre NY 11570-3800 Ph: (516) 410-7138 |
| NPI Number | 1053502518 |
|---|---|
| Provider Enumeration Date | 08/08/2007 |
| Last Update Date | 08/08/2007 |
| Medicare PECOS PAC ID | 4789776857 |
|---|---|
| Medicare Enrollment ID | O20070821000097 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053502518 | NPI | - | NPPES |
| 02735202 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Keri Lynn Mica Suttmiller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689617490 PECOS PAC ID: 9638183759 Enrollment ID: I20060127000545 |
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