| Meditelecare Of West Virginia Pllc | |
|
5400 Big Tyler Rd # D Charleston WV 25313-1178 | |
| (860) 788-6404 | |
| (860) 829-0495 |
| Full Name | Meditelecare Of West Virginia Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 5400 Big Tyler Rd # D, Charleston, West Virginia |
| Authorized Official Name and Position | Andrea Godfrey (CREDENTIALING & ENROLLMENT MANAGER) |
| Authorized Official Contact | 8607886404 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meditelecare Of West Virginia Pllc Po Box 1595 Middletown CT 06457-8095 Ph: (860) 788-6404 | Meditelecare Of West Virginia Pllc 5400 Big Tyler Rd # D Charleston WV 25313-1178 Ph: (860) 788-6404 |
| NPI Number | 1235631888 |
|---|---|
| Provider Enumeration Date | 02/28/2018 |
| Last Update Date | 09/04/2024 |
| Certification Date | 09/04/2024 |
| Medicare PECOS PAC ID | 5496018509 |
|---|---|
| Medicare Enrollment ID | O20180424000038 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235631888 | NPI | - | NPPES |
| Provider Name | Cheryl A France |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134144215 PECOS PAC ID: 1557550175 Enrollment ID: I20110113000601 |
| Provider Name | Erin N Krieg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619379526 PECOS PAC ID: 7517189491 Enrollment ID: I20150105002083 |
| Provider Name | Brenda Jo Brubaker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700307519 PECOS PAC ID: 9032475637 Enrollment ID: I20171115001482 |
| Provider Name | Deborah Lynn Story |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093909145 PECOS PAC ID: 6103015318 Enrollment ID: I20180123000418 |
| Provider Name | Camille N Griffith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1356829196 PECOS PAC ID: 4183960818 Enrollment ID: I20190116002609 |
| Provider Name | Leslie Ann Acosta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992191159 PECOS PAC ID: 2769799428 Enrollment ID: I20190321002721 |
| Provider Name | Theodore Joseph Dickens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306197603 PECOS PAC ID: 8325328768 Enrollment ID: I20190409000787 |
| Provider Name | Belinda Deone Tyner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225310881 PECOS PAC ID: 8527220862 Enrollment ID: I20190618001888 |
| Provider Name | Wilfredo Morges |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871007377 PECOS PAC ID: 8729347257 Enrollment ID: I20190920003085 |
| Provider Name | Sabrina Wilkerson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760789101 PECOS PAC ID: 5597904706 Enrollment ID: I20191104001955 |
| Provider Name | Holly Beth Kozee |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467783159 PECOS PAC ID: 5496902603 Enrollment ID: I20191209002085 |
| Provider Name | Marie Bissell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922393776 PECOS PAC ID: 2668650011 Enrollment ID: I20200616000007 |
| Provider Name | Bryce Lefever |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1205800620 PECOS PAC ID: 6204259625 Enrollment ID: I20200701003040 |
| Provider Name | Susan Weber |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1023349073 PECOS PAC ID: 1951432285 Enrollment ID: I20200729004140 |
| Provider Name | Julio Antonio Enriquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689981904 PECOS PAC ID: 5799083374 Enrollment ID: I20200812002110 |
| Provider Name | Christopher Staples |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992001762 PECOS PAC ID: 7810300407 Enrollment ID: I20201228000915 |
| Provider Name | Ninette Fernandes |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689996753 PECOS PAC ID: 2961803028 Enrollment ID: I20210625002449 |
| Provider Name | Angela Ohene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811476914 PECOS PAC ID: 1254729171 Enrollment ID: I20220830003425 |
| Provider Name | Latifat Amadin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336579556 PECOS PAC ID: 7719117167 Enrollment ID: I20221013003686 |
| Provider Name | Timothy Davis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740346253 PECOS PAC ID: 7810218658 Enrollment ID: I20230525000080 |
| Provider Name | Trisha Dawn Robinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245874320 PECOS PAC ID: 4981090990 Enrollment ID: I20230607000944 |
| Provider Name | Tracey Litwin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649532714 PECOS PAC ID: 9032366687 Enrollment ID: I20240207000109 |
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