| Paonia Psychotherapy Llc | |
|
211 Grand Ave Unit 112 Paonia CO 81428-5093 | |
| (312) 912-4845 | |
| Not Available |
| Full Name | Paonia Psychotherapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 211 Grand Ave Unit 112, Paonia, Colorado |
| Authorized Official Name and Position | Lindsay Cusack (OWNER) |
| Authorized Official Contact | 3129124845 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Paonia Psychotherapy Llc Po Box 502 Paonia CO 81428-0502 Ph: (312) 912-4845 | Paonia Psychotherapy Llc 211 Grand Ave Unit 112 Paonia CO 81428-5093 Ph: (312) 912-4845 |
| NPI Number | 1649915745 |
|---|---|
| Provider Enumeration Date | 05/03/2022 |
| Last Update Date | 05/03/2022 |
| Certification Date | 05/03/2022 |
| Medicare PECOS PAC ID | 1456734235 |
|---|---|
| Medicare Enrollment ID | O20220811000271 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649915745 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lindsay E Cusack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912121666 PECOS PAC ID: 5496007262 Enrollment ID: I20181004002551 |
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