| Tidewater Psychotherapy Services | |
|
260 Grayson Rd Suite 100 Virginia Beach VA 23462-4345 | |
| (757) 497-3670 | |
| (757) 499-1947 |
| Full Name | Tidewater Psychotherapy Services |
|---|---|
| Speciality | Social Worker |
| Location | 260 Grayson Rd, Virginia Beach, Virginia |
| Authorized Official Name and Position | Louise Friedman (PRESIDENT, AUTHORIZAED OFFICAL) |
| Authorized Official Contact | 7574973670 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidewater Psychotherapy Services 260 Grayson Rd Suite 100 Virginia Beach VA 23462-4345 Ph: (757) 497-3670 | Tidewater Psychotherapy Services 260 Grayson Rd Suite 100 Virginia Beach VA 23462-4345 Ph: (757) 497-3670 |
| NPI Number | 1700830742 |
|---|---|
| Provider Enumeration Date | 05/22/2006 |
| Last Update Date | 08/21/2017 |
| Medicare PECOS PAC ID | 9335128305 |
|---|---|
| Medicare Enrollment ID | O20040714001441 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700830742 | NPI | - | NPPES |
| 1700830742 | Medicaid | VA |
| Provider Name | Paul B Rosenberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558444786 PECOS PAC ID: 2769455955 Enrollment ID: I20040816001402 |
| Provider Name | Mariellen Blanton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245270909 PECOS PAC ID: 2567472707 Enrollment ID: I20060502000632 |
| Provider Name | Aaron G Childers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821070509 PECOS PAC ID: 5294899985 Enrollment ID: I20090124000017 |
| Provider Name | Stephen G Cunningham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780855114 PECOS PAC ID: 9931251329 Enrollment ID: I20090715000723 |
| Provider Name | Louise Boyd Friedman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467432518 PECOS PAC ID: 9032121157 Enrollment ID: I20101007000258 |
| Provider Name | Yongbing Larry Pu |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1083832661 PECOS PAC ID: 7416134929 Enrollment ID: I20130717000881 |
| Provider Name | Georgia S Phillips |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538523972 PECOS PAC ID: 0941591457 Enrollment ID: I20160614000184 |
| Provider Name | Arnella M Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457802795 PECOS PAC ID: 2860778099 Enrollment ID: I20170424001416 |
| Provider Name | Melanie Sabine Daniel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215493275 PECOS PAC ID: 5597006817 Enrollment ID: I20190412001899 |
| Provider Name | Alfreda Curtis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356997613 PECOS PAC ID: 4587091780 Enrollment ID: I20200228000669 |
| Provider Name | Edward James Evard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396344693 PECOS PAC ID: 5092129510 Enrollment ID: I20210125001748 |
| Provider Name | Tashia Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497888556 PECOS PAC ID: 2365859980 Enrollment ID: I20210329000063 |
| Provider Name | Masaru Nishiaoki |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1871026831 PECOS PAC ID: 5294143053 Enrollment ID: I20210623002155 |
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