| Neuropsychological Services Of Tidewater, Llc | |
|
2005 Pleasure House Rd Virginia Beach VA 23455 | |
| (757) 301-2248 | |
| (757) 689-8378 |
| Full Name | Neuropsychological Services Of Tidewater, Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 2005 Pleasure House Rd, Virginia Beach, Virginia |
| Authorized Official Name and Position | Jamie Ducharme (CLINICAL NEUROPSYCHOLOGIST) |
| Authorized Official Contact | 7573012248 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neuropsychological Services Of Tidewater, Llc 2005 Pleasure House Rd Virginia Beach VA 23455-2709 Ph: (757) 301-2248 | Neuropsychological Services Of Tidewater, Llc 2005 Pleasure House Rd Virginia Beach VA 23455 Ph: (757) 301-2248 |
| NPI Number | 1366956096 |
|---|---|
| Provider Enumeration Date | 11/16/2017 |
| Last Update Date | 03/01/2019 |
| Medicare PECOS PAC ID | 0345507372 |
|---|---|
| Medicare Enrollment ID | O20171130000444 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366956096 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 0810004265 (Virginia) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Jamie Ducharme |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659533610 PECOS PAC ID: 0244419398 Enrollment ID: I20110121000643 |
| Provider Name | Kimberley S Coddington |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467423756 PECOS PAC ID: 7618059908 Enrollment ID: I20200723003368 |
| Provider Name | Elizabeth R Jenks |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548961378 PECOS PAC ID: 9436519915 Enrollment ID: I20230714003385 |
| Provider Name | Brianna Bowman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205523677 PECOS PAC ID: 9830559921 Enrollment ID: I20230720003803 |
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