| Portico Erc, Llc | |
|
1253 Canyon Rd Morgantown WV 26508-9273 | |
| (304) 898-8389 | |
| Not Available |
| Full Name | Portico Erc, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1253 Canyon Rd, Morgantown, West Virginia |
| Authorized Official Name and Position | Elizabeth Rayanne Cichoski (CLINICAL THERAPIST) |
| Authorized Official Contact | 3042887928 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Portico Erc, Llc 245 Waitman St Morgantown WV 26501-7545 Ph: (304) 288-7928 | Portico Erc, Llc 1253 Canyon Rd Morgantown WV 26508-9273 Ph: (304) 898-8389 |
| NPI Number | 1508594961 |
|---|---|
| Provider Enumeration Date | 08/12/2022 |
| Last Update Date | 08/12/2022 |
| Certification Date | 08/12/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508594961 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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