| Phoenix Rising Therapeutic Services Lcsw Pc | |
|
5295 E Valley Rd Alfred Station NY 14803-9715 | |
| (607) 587-8260 | |
| Not Available |
| Full Name | Phoenix Rising Therapeutic Services Lcsw Pc |
|---|---|
| Speciality | Social Worker |
| Location | 5295 E Valley Rd, Alfred Station, New York |
| Authorized Official Name and Position | Mary Beth Mcdonough (SOLE OWNER) |
| Authorized Official Contact | 6075878260 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Rising Therapeutic Services Lcsw Pc 5295 E Valley Rd Alfred Station NY 14803-9715 Ph: (607) 587-8260 | Phoenix Rising Therapeutic Services Lcsw Pc 5295 E Valley Rd Alfred Station NY 14803-9715 Ph: (607) 587-8260 |
| NPI Number | 1003295395 |
|---|---|
| Provider Enumeration Date | 05/20/2015 |
| Last Update Date | 05/20/2015 |
| Medicare PECOS PAC ID | 2961794144 |
|---|---|
| Medicare Enrollment ID | O20160708000261 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003295395 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | R045595-1 (New York) | Primary |
| Provider Name | Mary Beth Mcdonough |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265442495 PECOS PAC ID: 3375550817 Enrollment ID: I20060308000704 |
Southern Tier Psychology, Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 591 State Route 244, Alfred Station, NY 14803 Phone: 585-204-7560 |