| Eastern Door Licensed Clinical Social Work, Pc | |
|
620 Washington Ave Rensselaer NY 12144-1300 | |
| (518) 252-7073 | |
| (518) 252-7073 |
| Full Name | Eastern Door Licensed Clinical Social Work, Pc |
|---|---|
| Speciality | Social Worker |
| Location | 620 Washington Ave, Rensselaer, New York |
| Authorized Official Name and Position | Kellyanne Rugenstein (OWNER) |
| Authorized Official Contact | 5182527073 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastern Door Licensed Clinical Social Work, Pc 620 Washington Ave Rensselaer NY 12144-1300 Ph: (518) 252-7073 | Eastern Door Licensed Clinical Social Work, Pc 620 Washington Ave Rensselaer NY 12144-1300 Ph: (518) 252-7073 |
| NPI Number | 1528500337 |
|---|---|
| Provider Enumeration Date | 11/10/2016 |
| Last Update Date | 03/26/2025 |
| Certification Date | 03/26/2025 |
| Medicare PECOS PAC ID | 8921522426 |
|---|---|
| Medicare Enrollment ID | O20250407000515 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528500337 | NPI | - | NPPES |
| 03068682 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kellyanne Rugenstein |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447363015 PECOS PAC ID: 3476528258 Enrollment ID: I20040826000960 |
St. Peters Health Partners Medical Associates Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 279 Troy Rd, Rensselaer, NY 12144 Phone: 518-694-3053 Fax: 518-694-3056 | |
Samaritan Hospital Of Troy, New York Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 279 Troy Rd, Rensselaer, NY 12144 Phone: 518-880-6320 | |
Ashley Townsend Lcsw, Pllc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 474 N Greenbush Rd Ste 1a, Rensselaer, NY 12144 Phone: 518-330-9716 |