| Modern Psych And Wellness Pllc | |
|
21415 Goddard Rd Taylor MI 48180-4247 | |
| (313) 737-0023 | |
| Not Available |
| Full Name | Modern Psych And Wellness Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 21415 Goddard Rd, Taylor, Michigan |
| Authorized Official Name and Position | Rana Succurro (OWNER) |
| Authorized Official Contact | 2486678014 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Psych And Wellness Pllc 21415 Goddard Rd Taylor MI 48180-4247 Ph: () - | Modern Psych And Wellness Pllc 21415 Goddard Rd Taylor MI 48180-4247 Ph: (313) 737-0023 |
| NPI Number | 1104674621 |
|---|---|
| Provider Enumeration Date | 05/09/2024 |
| Last Update Date | 09/30/2024 |
| Certification Date | 09/30/2024 |
| Medicare PECOS PAC ID | 8729529623 |
|---|---|
| Medicare Enrollment ID | O20240918004675 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104674621 | NPI | - | NPPES |
| Provider Name | Rana Raji Succurro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104313113 PECOS PAC ID: 3375933591 Enrollment ID: I20211202001340 |
| Provider Name | Alicia Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821648817 PECOS PAC ID: 2062945041 Enrollment ID: I20241029003730 |
| Provider Name | Persia A Coleman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861825341 PECOS PAC ID: 4981025772 Enrollment ID: I20241211000446 |
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