| Metanoia | |
|
2438 E Fountain Blvd Colorado Springs CO 80910-3227 | |
| (719) 799-2025 | |
| Not Available |
| Full Name | Metanoia |
|---|---|
| Speciality | Social Worker |
| Location | 2438 E Fountain Blvd, Colorado Springs, Colorado |
| Authorized Official Name and Position | Tanya Witman (OWNER) |
| Authorized Official Contact | 7193777669 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Metanoia 1 Kalisa Way Ste 101 Paramus NJ 07652-3508 Ph: (888) 948-6789 | Metanoia 2438 E Fountain Blvd Colorado Springs CO 80910-3227 Ph: (719) 799-2025 |
| NPI Number | 1376049429 |
|---|---|
| Provider Enumeration Date | 04/05/2018 |
| Last Update Date | 03/08/2023 |
| Certification Date | 03/08/2023 |
| Medicare PECOS PAC ID | 2466717665 |
|---|---|
| Medicare Enrollment ID | O20180517000491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376049429 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CSW.00000942 (Colorado) | Primary |
| Provider Name | Tanya R Carreon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750887725 PECOS PAC ID: 2860757077 Enrollment ID: I20180517001030 |
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