| Prime Psych Va, Llc | |
|
7751 Squirrel Level Rd North Dinwiddie VA 23803-7637 | |
| (804) 695-6633 | |
| (855) 978-2324 |
| Full Name | Prime Psych Va, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7751 Squirrel Level Rd, North Dinwiddie, Virginia |
| Authorized Official Name and Position | Frank Robert Rose (LICENSED CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 8046956633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Psych Va, Llc 1050 Temple Ave # 524 Colonial Heights VA 23834-2981 Ph: (804) 695-6633 | Prime Psych Va, Llc 7751 Squirrel Level Rd North Dinwiddie VA 23803-7637 Ph: (804) 695-6633 |
| NPI Number | 1306515812 |
|---|---|
| Provider Enumeration Date | 09/08/2021 |
| Last Update Date | 09/30/2022 |
| Certification Date | 09/30/2022 |
| Medicare PECOS PAC ID | 8022407741 |
|---|---|
| Medicare Enrollment ID | O20211117002440 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306515812 | NPI | - | NPPES |
| 1043738206 | Other | NPI TYPE 1 | |
| 0810005750 | Other | VA | VA LCP ID# |
| Provider Name | Frank Rose |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043738206 PECOS PAC ID: 0547513756 Enrollment ID: I20181105001036 |
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