| Psychology Resource Group | |
|
7400 New Lagrange Rd Suite 312 Louisville KY 40222-4870 | |
| (502) 394-9990 | |
| (502) 394-9990 |
| Full Name | Psychology Resource Group |
|---|---|
| Speciality | Psychologist |
| Location | 7400 New Lagrange Rd, Louisville, Kentucky |
| Authorized Official Name and Position | Larry M. Raskin (PRESIDENT) |
| Authorized Official Contact | 5023949990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychology Resource Group 7400 New Lagrange Rd Suite 312 Louisville KY 40222-4870 Ph: (502) 394-9990 | Psychology Resource Group 7400 New Lagrange Rd Suite 312 Louisville KY 40222-4870 Ph: (502) 394-9990 |
| NPI Number | 1952389389 |
|---|---|
| Provider Enumeration Date | 01/05/2006 |
| Last Update Date | 01/06/2011 |
| Medicare PECOS PAC ID | 5698757003 |
|---|---|
| Medicare Enrollment ID | O20040601000912 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952389389 | NPI | - | NPPES |
| 241408000 | Other | KY | MAGELLAN GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Wallace K Hicks |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1356320212 PECOS PAC ID: 6204901002 Enrollment ID: I20080813000449 |
| Provider Name | Larry M Raskin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750360624 PECOS PAC ID: 9133101546 Enrollment ID: I20081015000774 |
| Provider Name | Carol B Peterson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629056080 PECOS PAC ID: 5395877617 Enrollment ID: I20100721000637 |
| Provider Name | Anna R Bergman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235118191 PECOS PAC ID: 9436282563 Enrollment ID: I20100727000181 |
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