| Stacey Renee Tesauro Inc. | |
|
50 West Main Street Suite 704 Uniontown PA 15401 | |
| (724) 439-9698 | |
| (724) 439-9701 |
| Full Name | Stacey Renee Tesauro Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 50 West Main Street Suite 704, Uniontown, Pennsylvania |
| Authorized Official Name and Position | Stacey Renee Tesauro (PRESIDENT) |
| Authorized Official Contact | 7248801008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stacey Renee Tesauro Inc. 50 West Main Street Suite 704 Uniontown PA 15401 Ph: (724) 439-9698 | Stacey Renee Tesauro Inc. 50 West Main Street Suite 704 Uniontown PA 15401 Ph: (724) 439-9698 |
| NPI Number | 1194425603 |
|---|---|
| Provider Enumeration Date | 03/06/2023 |
| Last Update Date | 03/06/2023 |
| Certification Date | 03/04/2023 |
| Medicare PECOS PAC ID | 4880049782 |
|---|---|
| Medicare Enrollment ID | O20231012002893 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194425603 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Stacey R Tesauro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134399322 PECOS PAC ID: 1153407473 Enrollment ID: I20080327000300 |
| Provider Name | Erica Lynn Grim |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265981815 PECOS PAC ID: 5294159182 Enrollment ID: I20200724001417 |
| Provider Name | Tracy Ann Proctor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306489174 PECOS PAC ID: 7719373679 Enrollment ID: I20220404000113 |
| Provider Name | Whitney Jean Jordan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740687078 PECOS PAC ID: 6406290121 Enrollment ID: I20240221000437 |
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