| Pediatric And Family Behavioral Health Pllc | |
|
10420 Park Rd Ste 300 Charlotte NC 28210-8502 | |
| (980) 237-4766 | |
| (980) 404-2274 |
| Full Name | Pediatric And Family Behavioral Health Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 10420 Park Rd Ste 300, Charlotte, North Carolina |
| Authorized Official Name and Position | Luis Emilio Betancourt (PARTNER) |
| Authorized Official Contact | 7047707027 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric And Family Behavioral Health Pllc 10440 Park Rd Ste 300 Charlotte NC 28210-8544 Ph: (980) 237-4766 | Pediatric And Family Behavioral Health Pllc 10420 Park Rd Ste 300 Charlotte NC 28210-8502 Ph: (980) 237-4766 |
| NPI Number | 1770056038 |
|---|---|
| Provider Enumeration Date | 01/09/2019 |
| Last Update Date | 06/29/2023 |
| Certification Date | 06/29/2023 |
| Medicare PECOS PAC ID | 8820419120 |
|---|---|
| Medicare Enrollment ID | O20200521002294 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770056038 | NPI | - | NPPES |
| Provider Name | Ladeana W Gambill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538489414 PECOS PAC ID: 0042484263 Enrollment ID: I20111123000625 |
| Provider Name | Luis Emilio Betancourt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891076022 PECOS PAC ID: 6305067240 Enrollment ID: I20141018000028 |
| Provider Name | Kelly T Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215306956 PECOS PAC ID: 8123329430 Enrollment ID: I20151210001188 |
| Provider Name | Madhav R Muppa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841480373 PECOS PAC ID: 0840420907 Enrollment ID: I20160512001769 |
| Provider Name | Javier Santos Cubina |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588982755 PECOS PAC ID: 1355638271 Enrollment ID: I20160921000430 |
| Provider Name | David Balis Patton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548573231 PECOS PAC ID: 9234442534 Enrollment ID: I20180108000162 |
| Provider Name | Laura Harvey Nazzaro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689920357 PECOS PAC ID: 2668603416 Enrollment ID: I20201028001783 |
| Provider Name | Shanna Mago |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689918849 PECOS PAC ID: 0143471250 Enrollment ID: I20210317003043 |
| Provider Name | Valeea James Sutton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013412972 PECOS PAC ID: 0042575573 Enrollment ID: I20220815000380 |
| Provider Name | Micah Cartier Bright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669193330 PECOS PAC ID: 7012382930 Enrollment ID: I20230406002226 |
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