| South Suburban Psychological & Counseling Services, Pllc | |
|
4635 Nicols Rd Suite 200 Eagan MN 55122-3337 | |
| (952) 431-6862 | |
| Not Available |
| Full Name | South Suburban Psychological & Counseling Services, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 4635 Nicols Rd, Eagan, Minnesota |
| Authorized Official Name and Position | Michael James Ferrarese (PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 9524316862 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Suburban Psychological & Counseling Services, Pllc 4635 Nicols Rd Suite 200 Eagan MN 55122-3337 Ph: (952) 431-6862 | South Suburban Psychological & Counseling Services, Pllc 4635 Nicols Rd Suite 200 Eagan MN 55122-3337 Ph: (952) 431-6862 |
| NPI Number | 1477859437 |
|---|---|
| Provider Enumeration Date | 02/08/2011 |
| Last Update Date | 02/08/2011 |
| Medicare PECOS PAC ID | 1658556360 |
|---|---|
| Medicare Enrollment ID | O20110422000237 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477859437 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Michael J Ferrarese |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093868747 PECOS PAC ID: 3375581150 Enrollment ID: I20050421000951 |
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