| Revolution Psychology, Llc | |
|
245 E Broad St Ste B Greenville SC 29601-2896 | |
| (864) 417-9668 | |
| Not Available |
| Full Name | Revolution Psychology, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 245 E Broad St Ste B, Greenville, South Carolina |
| Authorized Official Name and Position | Joseph Paciarelli (PRESIDENT/CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 8644179668 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revolution Psychology, Llc 245 E Broad St Ste B Greenville SC 29601-2896 Ph: (864) 417-9668 | Revolution Psychology, Llc 245 E Broad St Ste B Greenville SC 29601-2896 Ph: (864) 417-9668 |
| NPI Number | 1346886801 |
|---|---|
| Provider Enumeration Date | 11/20/2019 |
| Last Update Date | 09/15/2022 |
| Certification Date | 09/15/2022 |
| Medicare PECOS PAC ID | 1557783586 |
|---|---|
| Medicare Enrollment ID | O20200622001181 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346886801 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Eugene J Paciarelli |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336478692 PECOS PAC ID: 7315169687 Enrollment ID: I20141121000553 |
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