| Supportive Care Of Vermont Llc | |
|
1478 Huntington Rd Richmond VT 05477-9726 | |
| (718) 298-4375 | |
| Not Available |
| Full Name | Supportive Care Of Vermont Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1478 Huntington Rd, Richmond, Vermont |
| Authorized Official Name and Position | Raphael Lichtschein (PRESIDENT) |
| Authorized Official Contact | 7182984375 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Supportive Care Of Vermont Llc 27 Randolph Rd Howell NJ 07731-8611 Ph: (718) 298-4375 | Supportive Care Of Vermont Llc 1478 Huntington Rd Richmond VT 05477-9726 Ph: (718) 298-4375 |
| NPI Number | 1245969690 |
|---|---|
| Provider Enumeration Date | 06/09/2022 |
| Last Update Date | 06/09/2022 |
| Certification Date | 06/09/2022 |
| Medicare PECOS PAC ID | 4688056484 |
|---|---|
| Medicare Enrollment ID | O20220726002274 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245969690 | NPI | - | NPPES |
| Provider Name | Tina Brownley-stevenson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730549031 PECOS PAC ID: 0840598108 Enrollment ID: I20160420000178 |
| Provider Name | Kerry O'hara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265989438 PECOS PAC ID: 5597043125 Enrollment ID: I20171213000408 |
| Provider Name | Cefora Goldszer Rubin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285878710 PECOS PAC ID: 7416221908 Enrollment ID: I20220726002512 |
| Provider Name | Eva Torres Maldonado |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164881736 PECOS PAC ID: 9032491022 Enrollment ID: I20230803001413 |
| Provider Name | Micah Ann Grant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952880791 PECOS PAC ID: 0648521377 Enrollment ID: I20231118000224 |
| Provider Name | Mariah Elizabeth Ertel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538935614 PECOS PAC ID: 7810336955 Enrollment ID: I20240422002393 |
| Provider Name | Nicole Marie Mancino |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831958750 PECOS PAC ID: 8820439441 Enrollment ID: I20240514004060 |
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