| Pine River Psychological Services PLLC | |
|
221 Bridge St Charlevoix MI 49720-1400 | |
| (650) 387-3927 | |
| Not Available |
| Full Name | Pine River Psychological Services PLLC |
|---|---|
| Speciality | Psychologist |
| Location | 221 Bridge St, Charlevoix, Michigan |
| Authorized Official Name and Position | Michael Di Martino (MANAGING MEMBER) |
| Authorized Official Contact | 6503873927 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine River Psychological Services PLLC 221 Bridge St Charlevoix MI 49720-1400 Ph: (650) 387-3927 | Pine River Psychological Services PLLC 221 Bridge St Charlevoix MI 49720-1400 Ph: (650) 387-3927 |
| NPI Number | 1992660005 |
|---|---|
| Provider Enumeration Date | 12/20/2025 |
| Last Update Date | 10/04/2026 |
| Certification Date | 10/04/2026 |
| Medicare PECOS PAC ID | 8820584972 |
|---|---|
| Medicare Enrollment ID | O20251229001694 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992660005 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (NU) | Primary |
| Provider Name | Michael Anthony Di Martino |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316505969 PECOS PAC ID: 0648766790 Enrollment ID: I20251229001795 |
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