| Phoenix Psychological Services, P.c. | |
|
1865 Amsterdam Ave New York NY 10031-1716 | |
| (323) 497-0980 | |
| Not Available |
| Full Name | Phoenix Psychological Services, P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 1865 Amsterdam Ave, New York, New York |
| Authorized Official Name and Position | Brickell Quarles (OWNER) |
| Authorized Official Contact | 3234970980 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Psychological Services, P.c. 725 River Rd Ste 32-110 Edgewater NJ 07020-1171 Ph: (323) 497-0980 | Phoenix Psychological Services, P.c. 1865 Amsterdam Ave New York NY 10031-1716 Ph: (323) 497-0980 |
| NPI Number | 1346763752 |
|---|---|
| Provider Enumeration Date | 07/18/2017 |
| Last Update Date | 07/18/2017 |
| Medicare PECOS PAC ID | 3476828112 |
|---|---|
| Medicare Enrollment ID | O20171006000436 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346763752 | NPI | - | NPPES |
| 02898915 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 016368 (New York) | Primary |
| Provider Name | Brickell Quarles |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801092770 PECOS PAC ID: 0749380343 Enrollment ID: I20070719000574 |
| Provider Name | Victor J Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447419874 PECOS PAC ID: 9335367929 Enrollment ID: I20140822001583 |
| Provider Name | Donna Miller-lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366938219 PECOS PAC ID: 7810240868 Enrollment ID: I20181206001659 |
| Provider Name | Dwayne D Poole-seymour |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003287665 PECOS PAC ID: 3870906613 Enrollment ID: I20210115000713 |
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