| Redeem Wellness Center, Llc | |
|
3180 Main St Ste 106 Bridgeport CT 06606-4237 | |
| (203) 208-3940 | |
| (203) 372-3272 |
| Full Name | Redeem Wellness Center, Llc |
|---|---|
| Speciality | Counselor |
| Location | 3180 Main St Ste 106, Bridgeport, Connecticut |
| Authorized Official Name and Position | Grace Cullen (MEDICAL BILLING MANAGER) |
| Authorized Official Contact | 2033685515 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Redeem Wellness Center, Llc 6405 Camden Rd Fayetteville NC 28306-7216 Ph: (910) 275-5766 | Redeem Wellness Center, Llc 3180 Main St Ste 106 Bridgeport CT 06606-4237 Ph: (203) 208-3940 |
| NPI Number | 1144876392 |
|---|---|
| Provider Enumeration Date | 08/14/2019 |
| Last Update Date | 09/22/2020 |
| Certification Date | 09/22/2020 |
| Medicare PECOS PAC ID | 2567807142 |
|---|---|
| Medicare Enrollment ID | O20240305003602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144876392 | NPI | - | NPPES |
| 004069985 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Secondary |
| Provider Name | Marcos Rosa |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1265099253 PECOS PAC ID: 1951746544 Enrollment ID: I20240321001507 |
| Provider Name | Valmir Delgado |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1023776853 PECOS PAC ID: 3870934789 Enrollment ID: I20240509001884 |
| Provider Name | Vivian Kannemeyer |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1477274819 PECOS PAC ID: 2668813502 Enrollment ID: I20240509002833 |
| Provider Name | Scott Simon |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1326702853 PECOS PAC ID: 6608217484 Enrollment ID: I20240510000736 |
| Provider Name | Diane Ferber |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1386225092 PECOS PAC ID: 3476994807 Enrollment ID: I20240515003972 |
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