| Mclean Professional Practice Group | |
|
115 Mill St Belmont MA 02478-1041 | |
| (617) 855-2183 | |
| (617) 855-3745 |
| Full Name | Mclean Professional Practice Group |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 115 Mill St, Belmont, Massachusetts |
| Authorized Official Name and Position | Joseph Gold (CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 6178552367 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mclean Professional Practice Group P.o. Box 5-0397 Woburn MA 01815-0397 Ph: (617) 855-2183 | Mclean Professional Practice Group 115 Mill St Belmont MA 02478-1041 Ph: (617) 855-2183 |
| NPI Number | 1114979580 |
|---|---|
| Provider Enumeration Date | 05/16/2006 |
| Last Update Date | 10/27/2010 |
| Medicare PECOS PAC ID | 9436040961 |
|---|---|
| Medicare Enrollment ID | O20040323001228 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114979580 | NPI | - | NPPES |
| 9778705 | Medicaid | MA | |
| M16400 | Other | MA | BC/BS |
| 1201174 | Medicaid | MA | |
| W10374 | Other | MA | BC/BS |
| Provider Name | Lisa Llanas Hagberg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831139377 PECOS PAC ID: 3476467002 Enrollment ID: I20031118000059 |
| Provider Name | Montgomery C Brower |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124069372 PECOS PAC ID: 2163326919 Enrollment ID: I20031122000040 |
| Provider Name | Elsa F Ronningstam |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891735106 PECOS PAC ID: 8022919976 Enrollment ID: I20040115000214 |
| Provider Name | Hudie B. Siegel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487759320 PECOS PAC ID: 8224939186 Enrollment ID: I20040115000242 |
| Provider Name | Medhat Migeed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699739722 PECOS PAC ID: 5294623278 Enrollment ID: I20040310000502 |
| Provider Name | Jacob C Holzer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144235433 PECOS PAC ID: 8224020599 Enrollment ID: I20040330000985 |
| Provider Name | Karsten D Kueppenbender |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265468292 PECOS PAC ID: 4688668601 Enrollment ID: I20040413000565 |
| Provider Name | Kevin P Hill |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407871122 PECOS PAC ID: 7416942875 Enrollment ID: I20040416000269 |
| Provider Name | Darin Dean Dougherty |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619968286 PECOS PAC ID: 8527055458 Enrollment ID: I20040430000475 |
| Provider Name | Michele L Masi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1386618502 PECOS PAC ID: 6709876824 Enrollment ID: I20040512001118 |
| Provider Name | Thomas J Weigel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306893748 PECOS PAC ID: 5193709244 Enrollment ID: I20040616000218 |
| Provider Name | Robert L Doyle |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609851658 PECOS PAC ID: 8820072705 Enrollment ID: I20040617000360 |
| Provider Name | Charles A Welch |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558335257 PECOS PAC ID: 5799761474 Enrollment ID: I20040624001125 |
| Provider Name | Alia Goodheart |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134234198 PECOS PAC ID: 5395724165 Enrollment ID: I20040715000696 |
| Provider Name | Brian P Brennan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255412136 PECOS PAC ID: 1052391828 Enrollment ID: I20040722000447 |
| Provider Name | Dost Ongur |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740267392 PECOS PAC ID: 1052381126 Enrollment ID: I20040727000967 |
| Provider Name | Constance N Ebong |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962443895 PECOS PAC ID: 1052381001 Enrollment ID: I20040728000587 |
| Provider Name | Byron Garcia |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780665794 PECOS PAC ID: 0941270441 Enrollment ID: I20040730000835 |
| Provider Name | Hilary S Connery |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659312635 PECOS PAC ID: 8820069560 Enrollment ID: I20040804001694 |
| Provider Name | Esther J Dechant |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073550760 PECOS PAC ID: 0042281792 Enrollment ID: I20040804001796 |
| Provider Name | Geoffrey S Young |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780663641 PECOS PAC ID: 7315924545 Enrollment ID: I20040810000997 |
| Provider Name | David J Alperovitz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407895980 PECOS PAC ID: 5597738922 Enrollment ID: I20040814000166 |
| Provider Name | Rakesh Karmacharya |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720078389 PECOS PAC ID: 5395710164 Enrollment ID: I20040826000866 |
| Provider Name | Miles G Cunningham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922014331 PECOS PAC ID: 2062488612 Enrollment ID: I20040907000185 |
| Provider Name | Aaron L Frenz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013906734 PECOS PAC ID: 3577531565 Enrollment ID: I20040917000681 |
| Provider Name | Elizabeth S Liebson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740227404 PECOS PAC ID: 2769451053 Enrollment ID: I20041004000129 |
| Provider Name | Amir Zamani |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1780679480 PECOS PAC ID: 4981698719 Enrollment ID: I20041110000738 |
| Provider Name | Oliver H Pomeroy |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1295720100 PECOS PAC ID: 1951365550 Enrollment ID: I20041115000051 |
| Provider Name | Fernando Rodriguez - Vil |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750316089 PECOS PAC ID: 6608831417 Enrollment ID: I20041122000243 |
| Provider Name | Charles S Wasserman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659361020 PECOS PAC ID: 7416915467 Enrollment ID: I20041222000499 |
| Provider Name | Maureen A Malin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043383847 PECOS PAC ID: 6002874864 Enrollment ID: I20041227000360 |
| Provider Name | Ruth J Reibstein |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982746129 PECOS PAC ID: 3476503087 Enrollment ID: I20050131000767 |
| Provider Name | Charu K Patel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780644294 PECOS PAC ID: 6800847161 Enrollment ID: I20050203000292 |
| Provider Name | Eliot M Gelwan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700952702 PECOS PAC ID: 5092767665 Enrollment ID: I20050211000730 |
| Provider Name | Loretta Givens |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1790767994 PECOS PAC ID: 0749260677 Enrollment ID: I20050317000793 |
| Provider Name | Grantley W Taylor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801977616 PECOS PAC ID: 0345296315 Enrollment ID: I20050323000922 |
| Provider Name | Gigi N Girgis |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1053387316 PECOS PAC ID: 8224084728 Enrollment ID: I20050328001069 |
| Provider Name | Robert B Portney |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437137346 PECOS PAC ID: 4486600863 Enrollment ID: I20050329000763 |
| Provider Name | Gopinath K Mallya |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467499160 PECOS PAC ID: 9335195734 Enrollment ID: I20050329000901 |
| Provider Name | Liangge Hsu |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1740265784 PECOS PAC ID: 3173560638 Enrollment ID: I20050415000340 |
| Provider Name | James D Wines |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942284336 PECOS PAC ID: 5597702092 Enrollment ID: I20050415000598 |
| Provider Name | Elizabeth T Murphy |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740224252 PECOS PAC ID: 9133167562 Enrollment ID: I20050418000627 |
| Provider Name | Eliza W Menninger |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609814029 PECOS PAC ID: 9335187798 Enrollment ID: I20050418000848 |
| Provider Name | Moinuddin H Muttakin |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1427158146 PECOS PAC ID: 4284674441 Enrollment ID: I20050506000212 |
| Provider Name | Lawrence F Berley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629164892 PECOS PAC ID: 9436199262 Enrollment ID: I20050511000039 |
| Provider Name | Franca Centorrino |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730140575 PECOS PAC ID: 2860432614 Enrollment ID: I20050511000274 |
| Provider Name | Roman A Klufas |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1598744427 PECOS PAC ID: 2860434586 Enrollment ID: I20050524000217 |
| Provider Name | Steven L Gans |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174581995 PECOS PAC ID: 4183666332 Enrollment ID: I20050526000937 |
| Provider Name | Mary E Barkalow |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700864485 PECOS PAC ID: 2668415167 Enrollment ID: I20050606000915 |
| Provider Name | Steven E Gelda |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710940341 PECOS PAC ID: 7113962218 Enrollment ID: I20050620000898 |
| Provider Name | Gary A Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083653216 PECOS PAC ID: 3971530486 Enrollment ID: I20050726000592 |
| Provider Name | Duncan C Maccourt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598714602 PECOS PAC ID: 5496783862 Enrollment ID: I20050728000165 |
| Provider Name | Karen A Walkey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619996303 PECOS PAC ID: 7416986450 Enrollment ID: I20050810000037 |
| Provider Name | Jason Guilford Jones |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629065123 PECOS PAC ID: 7416940564 Enrollment ID: I20050818000778 |
| Provider Name | David H Gill |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316933294 PECOS PAC ID: 3274564570 Enrollment ID: I20050826000146 |
| Provider Name | Lovella F Slusser |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1275615395 PECOS PAC ID: 1052343803 Enrollment ID: I20050901000351 |
| Provider Name | Wendy L Ranan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790732816 PECOS PAC ID: 9739113200 Enrollment ID: I20050923000360 |
| Provider Name | George W Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174514277 PECOS PAC ID: 4587698097 Enrollment ID: I20050923000732 |
| Provider Name | Lois A Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316029416 PECOS PAC ID: 8022034438 Enrollment ID: I20051014000649 |
| Provider Name | Patricia A Diaferio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184792285 PECOS PAC ID: 6305862012 Enrollment ID: I20051021000533 |
| Provider Name | J Alexander Bodkin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235222969 PECOS PAC ID: 8325064991 Enrollment ID: I20051022000154 |
| Provider Name | Richard S Schwartz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902847502 PECOS PAC ID: 0547287492 Enrollment ID: I20051029000172 |
| Provider Name | Kurt G Brenner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649226259 PECOS PAC ID: 4183642929 Enrollment ID: I20051109001090 |
| Provider Name | Kevin M Aubrey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477633741 PECOS PAC ID: 0345268009 Enrollment ID: I20051110000795 |
| Provider Name | William C Mcgrory |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629134762 PECOS PAC ID: 8325069024 Enrollment ID: I20051209000117 |
| Provider Name | John B Roseman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104808468 PECOS PAC ID: 2264453638 Enrollment ID: I20051213000501 |
| Provider Name | Jeffrey D Rediger |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871525675 PECOS PAC ID: 8729094024 Enrollment ID: I20060223000455 |
| Provider Name | Michael Fiori |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285648857 PECOS PAC ID: 3274576715 Enrollment ID: I20060315000439 |
| Provider Name | Evan D Murray |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1003892449 PECOS PAC ID: 6103834387 Enrollment ID: I20060329000653 |
| Provider Name | Arkadiy S Stolyar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780651174 PECOS PAC ID: 5698783819 Enrollment ID: I20060330000177 |
| Provider Name | Brent P Forester |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1649239716 PECOS PAC ID: 8527073626 Enrollment ID: I20060509000466 |
| Provider Name | Stephanie A Rickey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598785958 PECOS PAC ID: 2567475825 Enrollment ID: I20060803000299 |
| Provider Name | Gordana D Vitaliano |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053320192 PECOS PAC ID: 9638172026 Enrollment ID: I20060825000239 |
| Provider Name | Dawn Parker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902994726 PECOS PAC ID: 1153328794 Enrollment ID: I20061025000072 |
| Provider Name | Olivera J Bogunovic Sotelo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063526937 PECOS PAC ID: 1254227168 Enrollment ID: I20061128000245 |
| Provider Name | Oscar G Morales |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851367130 PECOS PAC ID: 8820063696 Enrollment ID: I20061220000308 |
| Provider Name | John M Rodolico |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043365638 PECOS PAC ID: 5395849590 Enrollment ID: I20070328000139 |
| Provider Name | Sarah E Oneil |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700876885 PECOS PAC ID: 6507964665 Enrollment ID: I20070613000457 |
| Provider Name | Lori K Carpenter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427103118 PECOS PAC ID: 5496848194 Enrollment ID: I20070912000033 |
| Provider Name | Charles Cho |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1740260025 PECOS PAC ID: 8426956772 Enrollment ID: I20071129000099 |
| Provider Name | Mark N Rudolph |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366490534 PECOS PAC ID: 4486737616 Enrollment ID: I20080212000291 |
| Provider Name | Igor Weinberg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578741195 PECOS PAC ID: 0749364768 Enrollment ID: I20080228000390 |
| Provider Name | Tatyana P Shteinlukht |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740268382 PECOS PAC ID: 9931285285 Enrollment ID: I20080326000792 |
| Provider Name | Jodie M O'malley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669640488 PECOS PAC ID: 4789760083 Enrollment ID: I20080327000097 |
| Provider Name | Peter J Siekmeier |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477590156 PECOS PAC ID: 2466521075 Enrollment ID: I20080522000493 |
| Provider Name | Glenn C Gaviola |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841460094 PECOS PAC ID: 2860566023 Enrollment ID: I20080806000174 |
| Provider Name | Gerardo Gonzalez Haddad |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720168271 PECOS PAC ID: 1052485034 Enrollment ID: I20080808000651 |
| Provider Name | Julieta Holman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386770709 PECOS PAC ID: 3971678798 Enrollment ID: I20080813000589 |
| Provider Name | Milissa L Kaufman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619003043 PECOS PAC ID: 1254406432 Enrollment ID: I20080822000374 |
| Provider Name | Allen R Schiller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407019672 PECOS PAC ID: 6103992839 Enrollment ID: I20080904000155 |
| Provider Name | Michael B Leslie |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851367395 PECOS PAC ID: 9638245236 Enrollment ID: I20080905000128 |
| Provider Name | Donald R Cluett |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710969381 PECOS PAC ID: 1355418005 Enrollment ID: I20080922000266 |
| Provider Name | Kirstin Marie Shu Small |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275601874 PECOS PAC ID: 7618044371 Enrollment ID: I20080922000368 |
| Provider Name | Srinivasan Mukundan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1003902172 PECOS PAC ID: 6204903800 Enrollment ID: I20080924000116 |
| Provider Name | Scott A Freeman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386750529 PECOS PAC ID: 6204885338 Enrollment ID: I20081017000118 |
| Provider Name | Nehal Shah |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073731147 PECOS PAC ID: 0345308300 Enrollment ID: I20081020000233 |
| Provider Name | Paula S Fuchs |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972543387 PECOS PAC ID: 7315006723 Enrollment ID: I20081030000033 |
| Provider Name | Andrew D Gill |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558445825 PECOS PAC ID: 5991864837 Enrollment ID: I20081106000223 |
| Provider Name | Amy E Dierberger |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1104044403 PECOS PAC ID: 4688734619 Enrollment ID: I20081120000889 |
| Provider Name | Carol R Hevia |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1700030574 PECOS PAC ID: 8426035635 Enrollment ID: I20081122000094 |
| Provider Name | Stephen J Seiner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245298835 PECOS PAC ID: 5597826669 Enrollment ID: I20081208000343 |
| Provider Name | Joanne M Keefe |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1760620934 PECOS PAC ID: 5597820571 Enrollment ID: I20090209000422 |
| Provider Name | Thomas Lee |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1356589980 PECOS PAC ID: 4183780331 Enrollment ID: I20090313000019 |
| Provider Name | Rachel D Tester |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1720253420 PECOS PAC ID: 1759438716 Enrollment ID: I20090408000205 |
| Provider Name | Andrea M Pliakas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316073729 PECOS PAC ID: 2961554415 Enrollment ID: I20090715000236 |
| Provider Name | Stacy Smith |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1659364925 PECOS PAC ID: 8628075231 Enrollment ID: I20091005000538 |
| Provider Name | Andrew M Kuller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538391602 PECOS PAC ID: 1850439159 Enrollment ID: I20091106000161 |
| Provider Name | Joseph B Stoklosa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043415565 PECOS PAC ID: 0648311241 Enrollment ID: I20100105000138 |
| Provider Name | Mary C Zanarini |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902852635 PECOS PAC ID: 5799826103 Enrollment ID: I20100107000489 |
| Provider Name | Monika E Kolodziej |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811024623 PECOS PAC ID: 8921141524 Enrollment ID: I20100204000466 |
| Provider Name | Kathryn S Kieran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689900946 PECOS PAC ID: 5890838494 Enrollment ID: I20100204000496 |
| Provider Name | Tatjana Dujmic |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336289099 PECOS PAC ID: 2365571726 Enrollment ID: I20100522000105 |
| Provider Name | John H Halpern |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093781908 PECOS PAC ID: 4183753114 Enrollment ID: I20100528000543 |
| Provider Name | Jenifer M Cullen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891883831 PECOS PAC ID: 9133259880 Enrollment ID: I20100607000905 |
| Provider Name | Raymond Huang |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1740428085 PECOS PAC ID: 1850425992 Enrollment ID: I20100811000864 |
| Provider Name | Sara L L Thomason |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760580161 PECOS PAC ID: 4284759531 Enrollment ID: I20100910000287 |
| Provider Name | Lisa Temple |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1306917422 PECOS PAC ID: 2163548009 Enrollment ID: I20100928001019 |
| Provider Name | Bernadette Hart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568572915 PECOS PAC ID: 1658331335 Enrollment ID: I20101119000613 |
| Provider Name | Joel B Solomon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881600120 PECOS PAC ID: 1052326477 Enrollment ID: I20101230000285 |
| Provider Name | Mark Centrella |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396717880 PECOS PAC ID: 4082803739 Enrollment ID: I20110111000403 |
| Provider Name | Nora Yousefzadeh Grunin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1932367778 PECOS PAC ID: 3072702547 Enrollment ID: I20110114000049 |
| Provider Name | Marc L Copersino |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578727517 PECOS PAC ID: 2365631785 Enrollment ID: I20110114000706 |
| Provider Name | Claire G Carswell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114008992 PECOS PAC ID: 3375725708 Enrollment ID: I20110307000711 |
| Provider Name | Roger G Pottanat |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396066874 PECOS PAC ID: 3072797679 Enrollment ID: I20110406000119 |
| Provider Name | Peter Bradford Adams |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710138011 PECOS PAC ID: 1759565781 Enrollment ID: I20110415000080 |
| Provider Name | Craig Boyajian |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831188200 PECOS PAC ID: 0143406439 Enrollment ID: I20110523000174 |
| Provider Name | Lorraine V Corso |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487693941 PECOS PAC ID: 5092992404 Enrollment ID: I20110613000667 |
| Provider Name | Alice W Asby |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174570063 PECOS PAC ID: 0749468841 Enrollment ID: I20110620000408 |
| Provider Name | Asha I Parekh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457434714 PECOS PAC ID: 2567640683 Enrollment ID: I20110620000553 |
| Provider Name | Nancy A Huxley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013996628 PECOS PAC ID: 5890973838 Enrollment ID: I20110622000603 |
| Provider Name | Donald A Davidoff |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1861431355 PECOS PAC ID: 8224216270 Enrollment ID: I20110622000645 |
| Provider Name | Erin B Sandler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184815763 PECOS PAC ID: 0749468601 Enrollment ID: I20110623000164 |
| Provider Name | Brandon T Unruh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952506479 PECOS PAC ID: 5799953816 Enrollment ID: I20110715000484 |
| Provider Name | Stephanie R R White Bateman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669509097 PECOS PAC ID: 7113195058 Enrollment ID: I20110721000055 |
| Provider Name | Theresa Maria Damien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841584299 PECOS PAC ID: 7810165271 Enrollment ID: I20110729000566 |
| Provider Name | Mark D Santello |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184679383 PECOS PAC ID: 0648448019 Enrollment ID: I20110730000017 |
| Provider Name | Beth L Murphy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164463352 PECOS PAC ID: 1759559149 Enrollment ID: I20110801000198 |
| Provider Name | Ana N Ticlea |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295986164 PECOS PAC ID: 1052366184 Enrollment ID: I20110802000807 |
| Provider Name | Zafar Nafis Naqvi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649429440 PECOS PAC ID: 4385815869 Enrollment ID: I20110913000465 |
| Provider Name | Ilana Warsofsky |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1508188228 PECOS PAC ID: 4284807215 Enrollment ID: I20111107000718 |
| Provider Name | Julie Brody Magid |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679637037 PECOS PAC ID: 7012984776 Enrollment ID: I20111220000687 |
| Provider Name | Alexis L Freedberg |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1336307065 PECOS PAC ID: 6709043326 Enrollment ID: I20120208000845 |
| Provider Name | Steven J Spitz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619915931 PECOS PAC ID: 0840453452 Enrollment ID: I20120518000007 |
| Provider Name | Noelle Rubel |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1467533083 PECOS PAC ID: 9739344466 Enrollment ID: I20120703000350 |
| Provider Name | William B Ruzicka |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225297765 PECOS PAC ID: 7719145283 Enrollment ID: I20120723000636 |
| Provider Name | Christopher M Tangren |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477712099 PECOS PAC ID: 9335308824 Enrollment ID: I20120808000075 |
| Provider Name | Kirsten W Bolton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033304233 PECOS PAC ID: 8921254731 Enrollment ID: I20120810000214 |
| Provider Name | Argyro P Caminis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184883795 PECOS PAC ID: 8820256407 Enrollment ID: I20120820000782 |
| Provider Name | Hon L Ho |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417151127 PECOS PAC ID: 1557511987 Enrollment ID: I20121022000173 |
| Provider Name | Manjola U Van Alphen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871745125 PECOS PAC ID: 9234389354 Enrollment ID: I20121026000375 |
| Provider Name | Meghan E S Shanahan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609157411 PECOS PAC ID: 0143470112 Enrollment ID: I20121029000382 |
| Provider Name | Judith Halperin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932258720 PECOS PAC ID: 6103078704 Enrollment ID: I20121205000470 |
| Provider Name | Simona Sava |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750692240 PECOS PAC ID: 4284888652 Enrollment ID: I20130212000339 |
| Provider Name | Shalisha K Crouch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487898904 PECOS PAC ID: 9537345947 Enrollment ID: I20130405000399 |
| Provider Name | Lynn M Carlson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861432528 PECOS PAC ID: 6608012620 Enrollment ID: I20130418000172 |
| Provider Name | Molly S Van Wert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104076702 PECOS PAC ID: 2365680840 Enrollment ID: I20130522000305 |
| Provider Name | Lauren V Moran |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174649131 PECOS PAC ID: 2769621309 Enrollment ID: I20130612000096 |
| Provider Name | Carlene M Macmillan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689801417 PECOS PAC ID: 8123286192 Enrollment ID: I20130614000582 |
| Provider Name | Michael Halassa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811124639 PECOS PAC ID: 0941469001 Enrollment ID: I20130628000535 |
| Provider Name | Lydia Y Cho |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053756106 PECOS PAC ID: 0941440523 Enrollment ID: I20130702000242 |
| Provider Name | Tiffany D Parcell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821340456 PECOS PAC ID: 6507006616 Enrollment ID: I20130715000321 |
| Provider Name | Michele M Collins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093014938 PECOS PAC ID: 9739321654 Enrollment ID: I20130806000264 |
| Provider Name | Stephanie C Valcourt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134440373 PECOS PAC ID: 5496913006 Enrollment ID: I20130819000085 |
| Provider Name | Nancy Radner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841631207 PECOS PAC ID: 8921242165 Enrollment ID: I20130910000348 |
| Provider Name | Sabra J Sullivan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366875437 PECOS PAC ID: 3476788894 Enrollment ID: I20131021000142 |
| Provider Name | Louisa E Dichard |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1275967499 PECOS PAC ID: 5597990184 Enrollment ID: I20131107000974 |
| Provider Name | Alex S Keuroghlian |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144541400 PECOS PAC ID: 7315105921 Enrollment ID: I20131119000547 |
| Provider Name | David Harris Rubin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871579367 PECOS PAC ID: 1658323704 Enrollment ID: I20140113001402 |
| Provider Name | John Teal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972897999 PECOS PAC ID: 6204095284 Enrollment ID: I20140124001342 |
| Provider Name | Carrie A Vaudreuil |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134443039 PECOS PAC ID: 6002054681 Enrollment ID: I20140204000274 |
| Provider Name | Veronika M Stock |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487970059 PECOS PAC ID: 5092945139 Enrollment ID: I20140311000735 |
| Provider Name | Matthew D Schrock |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033534771 PECOS PAC ID: 9830321587 Enrollment ID: I20140410001586 |
| Provider Name | Erin Rauscher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629271119 PECOS PAC ID: 5799729067 Enrollment ID: I20140430002451 |
| Provider Name | Katherine F Cederbaum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871874222 PECOS PAC ID: 1557594074 Enrollment ID: I20140507000601 |
| Provider Name | Neena Kapoor |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275760472 PECOS PAC ID: 9537307871 Enrollment ID: I20140528000755 |
| Provider Name | Rachel A Ross |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134440316 PECOS PAC ID: 9335307800 Enrollment ID: I20140612001518 |
| Provider Name | Rebecca K Mchugh |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598946329 PECOS PAC ID: 2062637895 Enrollment ID: I20140710000769 |
| Provider Name | Rachel B Weiss |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437563608 PECOS PAC ID: 8123243904 Enrollment ID: I20140711000007 |
| Provider Name | John M Beland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912114885 PECOS PAC ID: 5890911010 Enrollment ID: I20140724001526 |
| Provider Name | Danielle N Dahle |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306161849 PECOS PAC ID: 2466607684 Enrollment ID: I20140728002435 |
| Provider Name | Michael M Tang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710267778 PECOS PAC ID: 3971720194 Enrollment ID: I20140812002368 |
| Provider Name | Efrat Shavit |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396069951 PECOS PAC ID: 3870710999 Enrollment ID: I20140814000338 |
| Provider Name | Amal Abdulkadir |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396937751 PECOS PAC ID: 3577782168 Enrollment ID: I20140912001715 |
| Provider Name | Nina F Lewis-schroeder |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1144517145 PECOS PAC ID: 2567681745 Enrollment ID: I20140922000107 |
| Provider Name | Robert C Meisner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215104625 PECOS PAC ID: 3779712534 Enrollment ID: I20140923001653 |
| Provider Name | Amy M Rose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033527403 PECOS PAC ID: 1557581410 Enrollment ID: I20140929000815 |
| Provider Name | Laura M Diaz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326312984 PECOS PAC ID: 5294955449 Enrollment ID: I20141009002595 |
| Provider Name | Matthew P Lahaie |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144514167 PECOS PAC ID: 5597923201 Enrollment ID: I20141023000281 |
| Provider Name | Elisabeth J Moes |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972687440 PECOS PAC ID: 9638390297 Enrollment ID: I20141023000788 |
| Provider Name | Anil Varma V Vatsavayi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083861025 PECOS PAC ID: 7911221577 Enrollment ID: I20150130001519 |
| Provider Name | Kathi A Grafe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417350042 PECOS PAC ID: 3577888270 Enrollment ID: I20150220000148 |
| Provider Name | Robert Peter Drozek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730223413 PECOS PAC ID: 5799002143 Enrollment ID: I20150323001808 |
| Provider Name | Marta D Herschkopf |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306137492 PECOS PAC ID: 2668614009 Enrollment ID: I20150622001634 |
| Provider Name | Tracy A. Barbour |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902190937 PECOS PAC ID: 5597923151 Enrollment ID: I20150713001043 |
| Provider Name | Ying Cao |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538327523 PECOS PAC ID: 8022321728 Enrollment ID: I20150724010126 |
| Provider Name | Jennifer R Gatchel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053632398 PECOS PAC ID: 3870751498 Enrollment ID: I20150805007812 |
| Provider Name | Jessica A Dreifuss |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134502776 PECOS PAC ID: 9032424569 Enrollment ID: I20150813009376 |
| Provider Name | Perihan E Guvenek Cokol |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154657492 PECOS PAC ID: 8325354772 Enrollment ID: I20150831000758 |
| Provider Name | Willie O Siu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407142961 PECOS PAC ID: 7315105806 Enrollment ID: I20150904000418 |
| Provider Name | Arielle F Hall |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689050387 PECOS PAC ID: 9133436801 Enrollment ID: I20150911001762 |
| Provider Name | Kristina G Gaud |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508151598 PECOS PAC ID: 9032332861 Enrollment ID: I20150929000685 |
| Provider Name | Matthew A Robinson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255708939 PECOS PAC ID: 9335457811 Enrollment ID: I20151002000465 |
| Provider Name | Anthony D Sossong |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962798421 PECOS PAC ID: 4789843277 Enrollment ID: I20151014000550 |
| Provider Name | Iris Fadlon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346539202 PECOS PAC ID: 6709196447 Enrollment ID: I20151109000273 |
| Provider Name | Susan M Szulewski |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831251545 PECOS PAC ID: 9436231826 Enrollment ID: I20151216002676 |
| Provider Name | Marina Peters |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922449024 PECOS PAC ID: 7416250956 Enrollment ID: I20160118000202 |
| Provider Name | Joan P Gerring |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205880648 PECOS PAC ID: 3274639620 Enrollment ID: I20160203000318 |
| Provider Name | Patricia Mangones |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1679855407 PECOS PAC ID: 7416120837 Enrollment ID: I20160216000167 |
| Provider Name | Hadi Estakhri |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003161522 PECOS PAC ID: 5294030367 Enrollment ID: I20160226001902 |
| Provider Name | Kathryn D Broge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790131076 PECOS PAC ID: 6709183916 Enrollment ID: I20160401000282 |
| Provider Name | Ipsit V Vahia |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962638536 PECOS PAC ID: 6608911367 Enrollment ID: I20160406000467 |
| Provider Name | Michael J Murphy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548516289 PECOS PAC ID: 0547415739 Enrollment ID: I20160502001593 |
| Provider Name | James A Jenkins Ii |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235577313 PECOS PAC ID: 9830312909 Enrollment ID: I20160523001938 |
| Provider Name | Rebecca A Sanford |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1043432750 PECOS PAC ID: 4082904289 Enrollment ID: I20160531001657 |
| Provider Name | Diego Nunez |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457343790 PECOS PAC ID: 6305943929 Enrollment ID: I20160613000489 |
| Provider Name | Hermioni L. Amonoo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700149309 PECOS PAC ID: 3779738513 Enrollment ID: I20160701000603 |
| Provider Name | Noreen Woods |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588920177 PECOS PAC ID: 4981830536 Enrollment ID: I20160713002273 |
| Provider Name | Adrienne T Gerken |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912261470 PECOS PAC ID: 4284889924 Enrollment ID: I20160805002099 |
| Provider Name | David W Van Norstrand |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437413994 PECOS PAC ID: 8921252107 Enrollment ID: I20160823003134 |
| Provider Name | Sandra A Cutler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548554140 PECOS PAC ID: 7810282233 Enrollment ID: I20160824002795 |
| Provider Name | Ged Wieschhoff |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548556566 PECOS PAC ID: 8729226030 Enrollment ID: I20160907001737 |
| Provider Name | Agustin G Yip |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457413171 PECOS PAC ID: 2769555051 Enrollment ID: I20160927002581 |
| Provider Name | Violeta C. Valdivia |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245596717 PECOS PAC ID: 3779715172 Enrollment ID: I20161003001822 |
| Provider Name | Jennifer B Villa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215222344 PECOS PAC ID: 4587979299 Enrollment ID: I20161107001776 |
| Provider Name | Christine M Crawford |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154734374 PECOS PAC ID: 2961620927 Enrollment ID: I20170111000389 |
| Provider Name | Matthew N Desalvo |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1790124824 PECOS PAC ID: 7810114683 Enrollment ID: I20170113001147 |
| Provider Name | Elise I Welton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1306383351 PECOS PAC ID: 1759664287 Enrollment ID: I20170208000607 |
| Provider Name | Tatiana Farber Samlin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548718299 PECOS PAC ID: 4385921329 Enrollment ID: I20170501001292 |
| Provider Name | Kerry J Ressler |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558326785 PECOS PAC ID: 7911199898 Enrollment ID: I20170505000110 |
| Provider Name | Julia Lustick |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346582673 PECOS PAC ID: 4789806357 Enrollment ID: I20170628002388 |
| Provider Name | Allison Nelson-eliot |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528594256 PECOS PAC ID: 8224307111 Enrollment ID: I20170710000308 |
| Provider Name | Andrew Patrick Murray |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992146005 PECOS PAC ID: 6305135906 Enrollment ID: I20170714000816 |
| Provider Name | James M Wilkins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225392780 PECOS PAC ID: 7911151196 Enrollment ID: I20170718000250 |
| Provider Name | Anne B Rose |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629332184 PECOS PAC ID: 5193970911 Enrollment ID: I20170720001187 |
| Provider Name | Stephanie A Collier |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316238314 PECOS PAC ID: 6305116534 Enrollment ID: I20170721000094 |
| Provider Name | Vanessa M Cuthbert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356874770 PECOS PAC ID: 2860762606 Enrollment ID: I20170726003746 |
| Provider Name | Holly S Peek |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902162365 PECOS PAC ID: 1759696149 Enrollment ID: I20170816002589 |
| Provider Name | Robert J Fenster |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801141973 PECOS PAC ID: 7719281682 Enrollment ID: I20170823002536 |
| Provider Name | Nicole M Benson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801209945 PECOS PAC ID: 3971721325 Enrollment ID: I20170823003269 |
| Provider Name | Morgan M Medlock |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952749954 PECOS PAC ID: 5092943019 Enrollment ID: I20170920001137 |
| Provider Name | Mahdi Razafsha |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1912293689 PECOS PAC ID: 9234372566 Enrollment ID: I20171121003044 |
| Provider Name | Angela M Hakkila |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245489475 PECOS PAC ID: 5092072355 Enrollment ID: I20171122001381 |
| Provider Name | Christine Kim |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1467623322 PECOS PAC ID: 7618283268 Enrollment ID: I20171222000097 |
| Provider Name | Chloe Louise Pedalino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356620975 PECOS PAC ID: 2365702818 Enrollment ID: I20180201002430 |
| Provider Name | Shan Hai Siddiqi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285075887 PECOS PAC ID: 3577824358 Enrollment ID: I20180220000963 |
| Provider Name | Emily J Deringer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013233048 PECOS PAC ID: 1850540519 Enrollment ID: I20180222002589 |
| Provider Name | Jason W Krompinger |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326469446 PECOS PAC ID: 6305107962 Enrollment ID: I20180223000928 |
| Provider Name | Hyun Jung Kim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922241876 PECOS PAC ID: 4385863885 Enrollment ID: I20180224000050 |
| Provider Name | Michele Candrian |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942497565 PECOS PAC ID: 0941561187 Enrollment ID: I20180302001011 |
| Provider Name | Kristin N Javaras |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902258684 PECOS PAC ID: 2961765086 Enrollment ID: I20180424000483 |
| Provider Name | Thomas F Flood |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1093155541 PECOS PAC ID: 1456615699 Enrollment ID: I20180516000133 |
| Provider Name | Alok M Kanojia |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619380839 PECOS PAC ID: 5799905485 Enrollment ID: I20180524001495 |
| Provider Name | Martha J Falkenstein |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568984433 PECOS PAC ID: 5395090112 Enrollment ID: I20180620000249 |
| Provider Name | Bushra A Awidi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265848907 PECOS PAC ID: 2567717143 Enrollment ID: I20180622000941 |
| Provider Name | Erin C Dowd |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619380714 PECOS PAC ID: 9638397151 Enrollment ID: I20180625000819 |
| Provider Name | Christoforos I Giakoumatos |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336555267 PECOS PAC ID: 7113272667 Enrollment ID: I20180625000896 |
| Provider Name | Justin S Gillis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679060123 PECOS PAC ID: 2163772591 Enrollment ID: I20180906001031 |
| Provider Name | Luis Saura Beltran |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1750592333 PECOS PAC ID: 1951433499 Enrollment ID: I20180925003411 |
| Provider Name | Nathaniel P Van Kirk |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528599313 PECOS PAC ID: 3971856386 Enrollment ID: I20181101002346 |
| Provider Name | Courtney B Elias |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588978316 PECOS PAC ID: 7416200720 Enrollment ID: I20181101002841 |
| Provider Name | Susan M Cullaty-purvis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184199747 PECOS PAC ID: 5496009185 Enrollment ID: I20181115001815 |
| Provider Name | Ana Gomes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508374042 PECOS PAC ID: 0749534436 Enrollment ID: I20181115001871 |
| Provider Name | Blake T Hilton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295253144 PECOS PAC ID: 5890049209 Enrollment ID: I20181120002574 |
| Provider Name | Meredith S Morrison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477055333 PECOS PAC ID: 8921344185 Enrollment ID: I20190108003618 |
| Provider Name | Kevin J Li |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114377926 PECOS PAC ID: 9739425901 Enrollment ID: I20190108004108 |
| Provider Name | William K Bache |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619312774 PECOS PAC ID: 5991043739 Enrollment ID: I20190220002503 |
| Provider Name | Margaret Crowder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124451380 PECOS PAC ID: 1153555032 Enrollment ID: I20190228001406 |
| Provider Name | Suzanne E Bloore |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679816011 PECOS PAC ID: 0749417988 Enrollment ID: I20190422002275 |
| Provider Name | Andrew Stephen Cruz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730569674 PECOS PAC ID: 3274820071 Enrollment ID: I20190508001329 |
| Provider Name | Aleksandra S Phillips |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316018450 PECOS PAC ID: 7012969439 Enrollment ID: I20190515001611 |
| Provider Name | Emily M Sorg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639550353 PECOS PAC ID: 4688989643 Enrollment ID: I20190516001071 |
| Provider Name | Elizabeth N Madva |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558742262 PECOS PAC ID: 0840505616 Enrollment ID: I20190521003164 |
| Provider Name | Hayley Paret |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104348663 PECOS PAC ID: 0446593016 Enrollment ID: I20190522002019 |
| Provider Name | Mahesh B Jhangiani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407238223 PECOS PAC ID: 7911230917 Enrollment ID: I20190606000583 |
| Provider Name | Geoffrey Z Liu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215318928 PECOS PAC ID: 0042520116 Enrollment ID: I20190611000500 |
| Provider Name | Emeric Bojarski |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669715090 PECOS PAC ID: 0547549172 Enrollment ID: I20190613001034 |
| Provider Name | Jillbeth V Sweeney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861968380 PECOS PAC ID: 4486987088 Enrollment ID: I20190613002631 |
| Provider Name | Lauren Kay Broderick |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588046213 PECOS PAC ID: 5698081867 Enrollment ID: I20190617002134 |
| Provider Name | Caroline S Bader |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538587589 PECOS PAC ID: 7012135437 Enrollment ID: I20190619002008 |
| Provider Name | Jeffrey P Guenette |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1093154056 PECOS PAC ID: 5698992337 Enrollment ID: I20190624001665 |
| Provider Name | Amanda E Sedgewick |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588076715 PECOS PAC ID: 8123244050 Enrollment ID: I20190705000664 |
| Provider Name | Karen S Kantor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407224686 PECOS PAC ID: 8628303534 Enrollment ID: I20190716000141 |
| Provider Name | Brian William Boyle |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871974584 PECOS PAC ID: 3173839719 Enrollment ID: I20190716002485 |
| Provider Name | Meghan C Schreck |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093238495 PECOS PAC ID: 9931435328 Enrollment ID: I20190723002117 |
| Provider Name | Martyna Rusinowicz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831670389 PECOS PAC ID: 9032448428 Enrollment ID: I20190910003016 |
| Provider Name | Heather R Denisco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487121638 PECOS PAC ID: 1850621046 Enrollment ID: I20191002000319 |
| Provider Name | Jennifer J Holiman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235484882 PECOS PAC ID: 5890026611 Enrollment ID: I20191009002095 |
| Provider Name | Cara Sypher-sieger |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1710539432 PECOS PAC ID: 5193158459 Enrollment ID: I20191127002520 |
| Provider Name | Omotola T'sarumi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710369376 PECOS PAC ID: 6507290012 Enrollment ID: I20191216001913 |
| Provider Name | Shuang Li |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326433863 PECOS PAC ID: 0547510612 Enrollment ID: I20200107000191 |
| Provider Name | Jessica M Margolis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659932705 PECOS PAC ID: 9335573971 Enrollment ID: I20200107001856 |
| Provider Name | Michael D Kritzer-cheren |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578950549 PECOS PAC ID: 1658600655 Enrollment ID: I20200204002334 |
| Provider Name | Jennifer R Fanning |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821383258 PECOS PAC ID: 5193099042 Enrollment ID: I20200205002440 |
| Provider Name | Christopher Hicks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710394994 PECOS PAC ID: 9234457482 Enrollment ID: I20200206001867 |
| Provider Name | Olivia Booth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184000879 PECOS PAC ID: 5799095410 Enrollment ID: I20200313000646 |
| Provider Name | Jessica Becker |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326429036 PECOS PAC ID: 8527374099 Enrollment ID: I20200319002283 |
| Provider Name | Andrew Melaragno |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740636653 PECOS PAC ID: 4284921016 Enrollment ID: I20200325003215 |
| Provider Name | Tiffany Osborne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932748480 PECOS PAC ID: 7214368182 Enrollment ID: I20200508000699 |
| Provider Name | Sara M Bahouth |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1063899425 PECOS PAC ID: 5698106912 Enrollment ID: I20200520001726 |
| Provider Name | Raymond S Levesque |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972638567 PECOS PAC ID: 7012338239 Enrollment ID: I20200526001846 |
| Provider Name | Ashley Beaulieu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023490638 PECOS PAC ID: 8224459029 Enrollment ID: I20200603001573 |
| Provider Name | Jungjin Kim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528488376 PECOS PAC ID: 7618228891 Enrollment ID: I20200603002852 |
| Provider Name | David G Frederick |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669820296 PECOS PAC ID: 6406143213 Enrollment ID: I20200604002127 |
| Provider Name | Rebecca F Coltin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043642325 PECOS PAC ID: 9133541402 Enrollment ID: I20200616001062 |
| Provider Name | Nathan C Praschan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902328396 PECOS PAC ID: 2163795485 Enrollment ID: I20200708001222 |
| Provider Name | Cary S. Crall |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023466653 PECOS PAC ID: 5193005932 Enrollment ID: I20200714002945 |
| Provider Name | Kayia Lolita Akoun |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588028732 PECOS PAC ID: 5991099459 Enrollment ID: I20200721002731 |
| Provider Name | Amanda Bennett |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689025330 PECOS PAC ID: 9234496845 Enrollment ID: I20200805000858 |
| Provider Name | Alisha R Moreland |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225270408 PECOS PAC ID: 4486809126 Enrollment ID: I20200827002074 |
| Provider Name | Heidi A Browne |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295197358 PECOS PAC ID: 1658625389 Enrollment ID: I20200911001159 |
| Provider Name | Joseph B Bond |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679968689 PECOS PAC ID: 3678871746 Enrollment ID: I20201019003116 |
| Provider Name | Corina S Laudate |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801378419 PECOS PAC ID: 2567873995 Enrollment ID: I20201116001837 |
| Provider Name | Melissa J Derosa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528470127 PECOS PAC ID: 4981015815 Enrollment ID: I20201127000118 |
| Provider Name | Vona F Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922059781 PECOS PAC ID: 8325450752 Enrollment ID: I20201209001089 |
| Provider Name | Allison Corman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124661566 PECOS PAC ID: 5395157242 Enrollment ID: I20201217000497 |
| Provider Name | Rahel S. Bosson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083905970 PECOS PAC ID: 8628290756 Enrollment ID: I20201224000136 |
| Provider Name | Fernando Espi Forcen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003049792 PECOS PAC ID: 0143536169 Enrollment ID: I20201228000827 |
| Provider Name | Noa H Kupfer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083221428 PECOS PAC ID: 7012321581 Enrollment ID: I20210123000039 |
| Provider Name | Daniel M Epelbaum |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538321773 PECOS PAC ID: 7416089073 Enrollment ID: I20210127001578 |
| Provider Name | Caleb Z Demers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578162707 PECOS PAC ID: 8527474485 Enrollment ID: I20210302000414 |
| Provider Name | Simon F Desjardins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821387580 PECOS PAC ID: 5294035101 Enrollment ID: I20210302000717 |
| Provider Name | Alexandra M Dick |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225629504 PECOS PAC ID: 6709293681 Enrollment ID: I20210319000733 |
| Provider Name | Rita Asiegbunam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376160887 PECOS PAC ID: 6002223237 Enrollment ID: I20210405002170 |
| Provider Name | Kaitlin Barnea |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043806987 PECOS PAC ID: 9931518305 Enrollment ID: I20210514001893 |
| Provider Name | Colin W Burke |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699188813 PECOS PAC ID: 9739307273 Enrollment ID: I20210611000201 |
| Provider Name | Adam W Henderson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265960025 PECOS PAC ID: 5597038711 Enrollment ID: I20210611000247 |
| Provider Name | Briana F Borenstein |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811419096 PECOS PAC ID: 6406256312 Enrollment ID: I20210615001576 |
| Provider Name | Andrew Wu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528599198 PECOS PAC ID: 4880095777 Enrollment ID: I20210629003750 |
| Provider Name | Matthew J Mosquera |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598157323 PECOS PAC ID: 7315349586 Enrollment ID: I20210709002161 |
| Provider Name | Laura A Dicola |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861841173 PECOS PAC ID: 9739476540 Enrollment ID: I20210715000599 |
| Provider Name | Abdelbassat M Zerguine |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548655384 PECOS PAC ID: 9931400165 Enrollment ID: I20210809001673 |
| Provider Name | Loren Michael Post |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376903849 PECOS PAC ID: 4385935972 Enrollment ID: I20210824003439 |
| Provider Name | Edward L Lyons |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1053499178 PECOS PAC ID: 1052212107 Enrollment ID: I20210831000648 |
| Provider Name | Ruth Lauren Firmin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689233702 PECOS PAC ID: 5395077366 Enrollment ID: I20210908000798 |
| Provider Name | Ana F Trueba Yepez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376121657 PECOS PAC ID: 1658777040 Enrollment ID: I20210910000079 |
| Provider Name | Ranjani Logaraj |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740711712 PECOS PAC ID: 8022415066 Enrollment ID: I20210917002430 |
| Provider Name | Annika Holmberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427618677 PECOS PAC ID: 3779918362 Enrollment ID: I20211005000382 |
| Provider Name | Marc S Weinberg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700375698 PECOS PAC ID: 0244581486 Enrollment ID: I20211118002526 |
| Provider Name | Taylor Brooke Melville |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518480730 PECOS PAC ID: 7517211550 Enrollment ID: I20211201001227 |
| Provider Name | Poonam K Modha |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679611842 PECOS PAC ID: 1153467444 Enrollment ID: I20220209000402 |
| Provider Name | Jennifer L Goetz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871931956 PECOS PAC ID: 1658509757 Enrollment ID: I20220209002568 |
| Provider Name | Jessica Slicer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609354349 PECOS PAC ID: 2365839214 Enrollment ID: I20220425001778 |
| Provider Name | Shobana Raghuram Modur |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114407350 PECOS PAC ID: 2668869967 Enrollment ID: I20220504001983 |
| Provider Name | Sarah D Muscat |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659364420 PECOS PAC ID: 3971536178 Enrollment ID: I20220507000018 |
| Provider Name | Linda J Herrera Santos |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285123505 PECOS PAC ID: 2769733922 Enrollment ID: I20220526002824 |
| Provider Name | Jonathan S Vogelgsang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982350054 PECOS PAC ID: 0648658716 Enrollment ID: I20220601001729 |
| Provider Name | Regan E Patrick |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881363513 PECOS PAC ID: 4284012030 Enrollment ID: I20220607000644 |
| Provider Name | Sajel H Shah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407388937 PECOS PAC ID: 1456621127 Enrollment ID: I20220607003116 |
| Provider Name | Zachary S Grunau |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568952349 PECOS PAC ID: 6800147083 Enrollment ID: I20220621000635 |
| Provider Name | Reuben A Hendler |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760971444 PECOS PAC ID: 8224389499 Enrollment ID: I20220621001555 |
| Provider Name | Timothy J Shea |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518457753 PECOS PAC ID: 7416208657 Enrollment ID: I20220622000380 |
| Provider Name | Shifali Singh |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467064543 PECOS PAC ID: 2668851643 Enrollment ID: I20220622000654 |
| Provider Name | Michaela B Swee |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558987826 PECOS PAC ID: 0042690075 Enrollment ID: I20220707002349 |
| Provider Name | Jisoo Kim |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1770939399 PECOS PAC ID: 9133410798 Enrollment ID: I20220711000115 |
| Provider Name | Alexander M Moscicki |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457841686 PECOS PAC ID: 0143571497 Enrollment ID: I20220712001715 |
| Provider Name | William C Olcott |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114414828 PECOS PAC ID: 6204217888 Enrollment ID: I20220713002509 |
| Provider Name | Marie Clouqueur |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366843658 PECOS PAC ID: 5890176002 Enrollment ID: I20220720000179 |
| Provider Name | Neil A Meyer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568024222 PECOS PAC ID: 5496136624 Enrollment ID: I20220720000759 |
| Provider Name | Matthew J Bradley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225523947 PECOS PAC ID: 9830440544 Enrollment ID: I20220721001359 |
| Provider Name | Josephine S Au |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255986238 PECOS PAC ID: 8224419262 Enrollment ID: I20220721002168 |
| Provider Name | Jesse E Moskowitz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942795273 PECOS PAC ID: 1052663515 Enrollment ID: I20220722000238 |
| Provider Name | Erik K Loken |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1568817187 PECOS PAC ID: 2466746920 Enrollment ID: I20220726000883 |
| Provider Name | Patrick L Mcguire |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023540564 PECOS PAC ID: 9234401779 Enrollment ID: I20220802003325 |
| Provider Name | Sara Louise Weisenbach |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912179128 PECOS PAC ID: 8628147055 Enrollment ID: I20220805002690 |
| Provider Name | Sanjali Kumar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972009033 PECOS PAC ID: 8426308735 Enrollment ID: I20220822001383 |
| Provider Name | Jessenia P Arias |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053759068 PECOS PAC ID: 5092199117 Enrollment ID: I20220908001141 |
| Provider Name | Sinhae Cho |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295396802 PECOS PAC ID: 7719362441 Enrollment ID: I20220916001714 |
| Provider Name | Elizabeth J Lewis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649701665 PECOS PAC ID: 0345625745 Enrollment ID: I20220921003148 |
| Provider Name | Cherman E Pierre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821447608 PECOS PAC ID: 9436525573 Enrollment ID: I20221014001833 |
| Provider Name | Olena Dreyfus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063130656 PECOS PAC ID: 9931575081 Enrollment ID: I20221014001985 |
| Provider Name | Michal Mcdowell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952891046 PECOS PAC ID: 2769733955 Enrollment ID: I20221020003084 |
| Provider Name | Julia S Kaufman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851960710 PECOS PAC ID: 7416324843 Enrollment ID: I20221027002421 |
| Provider Name | Nicole Sauve |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770981243 PECOS PAC ID: 6800263435 Enrollment ID: I20221110000855 |
| Provider Name | Tamara P Welikson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366045155 PECOS PAC ID: 8527437102 Enrollment ID: I20221205001167 |
| Provider Name | Kristin A Bevington |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871083121 PECOS PAC ID: 4880945039 Enrollment ID: I20221219000635 |
| Provider Name | Laura E Thurlow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215691167 PECOS PAC ID: 4486025376 Enrollment ID: I20230201002168 |
| Provider Name | Katherine E Ledermann |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760078521 PECOS PAC ID: 5496127292 Enrollment ID: I20230203001336 |
| Provider Name | Kjersten L Johnsen |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1407172588 PECOS PAC ID: 2365814753 Enrollment ID: I20230213001055 |
| Provider Name | Elizabeth M Carey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851005599 PECOS PAC ID: 6103299029 Enrollment ID: I20230223002091 |
| Provider Name | Lori R Solon |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1710332879 PECOS PAC ID: 2466825385 Enrollment ID: I20230223002118 |
| Provider Name | Antonia Mariani |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215402417 PECOS PAC ID: 9638542863 Enrollment ID: I20230308002036 |
| Provider Name | Maddison R Norton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356061410 PECOS PAC ID: 9335512482 Enrollment ID: I20230310001291 |
| Provider Name | Joshua C Brown |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851706980 PECOS PAC ID: 2961729611 Enrollment ID: I20230405000325 |
| Provider Name | Blake L Rosenbaum |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053871871 PECOS PAC ID: 5799015608 Enrollment ID: I20230505001465 |
| Provider Name | Anastasia B Evanoff |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538629951 PECOS PAC ID: 4486984341 Enrollment ID: I20230516000699 |
| Provider Name | Zachary B Millman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396306205 PECOS PAC ID: 9830555655 Enrollment ID: I20230522002067 |
| Provider Name | Anastasia M Samaras |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720575798 PECOS PAC ID: 2264898907 Enrollment ID: I20230522003129 |
| Provider Name | Saeed Hashem |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538690011 PECOS PAC ID: 8729325832 Enrollment ID: I20230525000562 |
| Provider Name | Amber N Edinoff |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144545344 PECOS PAC ID: 8022347319 Enrollment ID: I20230530000788 |
| Provider Name | Hillary L Woodworth |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578025821 PECOS PAC ID: 7618207234 Enrollment ID: I20230613002412 |
| Provider Name | Diana L Stern |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376003863 PECOS PAC ID: 1951631894 Enrollment ID: I20230614001547 |
| Provider Name | Kelly J Brown |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134575160 PECOS PAC ID: 3173819240 Enrollment ID: I20230616000264 |
| Provider Name | Alesia A Cloutier |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699339234 PECOS PAC ID: 7012376262 Enrollment ID: I20230706000604 |
| Provider Name | Julia M Tom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811635907 PECOS PAC ID: 8123487956 Enrollment ID: I20230711002430 |
| Provider Name | Ana Marie Rodriguez-villa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558822247 PECOS PAC ID: 3375873284 Enrollment ID: I20230712001811 |
| Provider Name | Mary D Rockas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174010045 PECOS PAC ID: 5092052274 Enrollment ID: I20230718000454 |
| Provider Name | Shane A Fischbach |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740740075 PECOS PAC ID: 4385004712 Enrollment ID: I20230718000680 |
| Provider Name | Steven T Taylor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114487584 PECOS PAC ID: 6204166119 Enrollment ID: I20230718002642 |
| Provider Name | Nicholas G Larussa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114681186 PECOS PAC ID: 3476914615 Enrollment ID: I20230803002335 |
| Provider Name | Elliott R Eggan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598225781 PECOS PAC ID: 3870822349 Enrollment ID: I20230804000310 |
| Provider Name | Aliza T Stein |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275109316 PECOS PAC ID: 1153785373 Enrollment ID: I20230906003562 |
| Provider Name | Katherine A Orlowski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942784764 PECOS PAC ID: 6800223108 Enrollment ID: I20230926000278 |
| Provider Name | Ryan J Piers |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508591280 PECOS PAC ID: 6305290271 Enrollment ID: I20230926002709 |
| Provider Name | Brittany R King |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1700519709 PECOS PAC ID: 8527413277 Enrollment ID: I20231016002102 |
| Provider Name | Matthew J Bulger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679261465 PECOS PAC ID: 6901252667 Enrollment ID: I20231101000867 |
| Provider Name | Kevin J Mcnamara |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376061614 PECOS PAC ID: 1557718442 Enrollment ID: I20231115000494 |
| Provider Name | Andrew Minoru Fukuda |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053806497 PECOS PAC ID: 1052665569 Enrollment ID: I20231215002682 |
| Provider Name | Christine L Picard |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1760684708 PECOS PAC ID: 2466481643 Enrollment ID: I20240130001186 |
| Provider Name | Chloe Gabrielle Sharp |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316506355 PECOS PAC ID: 9830426691 Enrollment ID: I20240314001129 |
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