| Supportive Care Of Michigan Llc | |
|
330 Lincoln Ave Iron River MI 49935-8452 | |
| (718) 298-2753 | |
| Not Available |
| Full Name | Supportive Care Of Michigan Llc |
|---|---|
| Speciality | Psychologist |
| Location | 330 Lincoln Ave, Iron River, Michigan |
| Authorized Official Name and Position | Raphael Lichtschein (PRESIDENT) |
| Authorized Official Contact | 7182984375 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Supportive Care Of Michigan Llc 27 Randolph Rd Howell NJ 07731-8611 Ph: (718) 298-2753 | Supportive Care Of Michigan Llc 330 Lincoln Ave Iron River MI 49935-8452 Ph: (718) 298-2753 |
| NPI Number | 1659030591 |
|---|---|
| Provider Enumeration Date | 12/08/2021 |
| Last Update Date | 12/08/2021 |
| Certification Date | 12/08/2021 |
| Medicare PECOS PAC ID | 1254723182 |
|---|---|
| Medicare Enrollment ID | O20220126001132 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659030591 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Richard E James |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750325262 PECOS PAC ID: 7517979974 Enrollment ID: I20060629000196 |
| Provider Name | Kamera S Boggon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700247772 PECOS PAC ID: 2769772995 Enrollment ID: I20160531002509 |
| Provider Name | Petra Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033667514 PECOS PAC ID: 2961790985 Enrollment ID: I20161006002271 |
| Provider Name | David James Majors |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922401207 PECOS PAC ID: 3779970884 Enrollment ID: I20220420000319 |
| Provider Name | Leatta Elizabeth Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720455900 PECOS PAC ID: 0941689632 Enrollment ID: I20220627002868 |
| Provider Name | Rolandia T Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366848350 PECOS PAC ID: 6709266398 Enrollment ID: I20220628003400 |
| Provider Name | Misty M Tessens Veatch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376986588 PECOS PAC ID: 1052791621 Enrollment ID: I20220629002560 |
| Provider Name | Almond Mcswain |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184073140 PECOS PAC ID: 7214319623 Enrollment ID: I20220802001440 |
| Provider Name | Daniel Alfonso Grasso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649900234 PECOS PAC ID: 3476929183 Enrollment ID: I20221021000252 |
| Provider Name | Darcy L Paisley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134851074 PECOS PAC ID: 3779614813 Enrollment ID: I20221107001912 |
| Provider Name | Joanna Woodward Mcabee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790058923 PECOS PAC ID: 7113178831 Enrollment ID: I20221118000932 |
| Provider Name | Shawn O Utsey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134899958 PECOS PAC ID: 9537558655 Enrollment ID: I20221129000852 |
| Provider Name | Lydia Emuobosa Opara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558955054 PECOS PAC ID: 9436554649 Enrollment ID: I20221129001129 |
| Provider Name | Joshua Gonsher |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912493297 PECOS PAC ID: 3072948744 Enrollment ID: I20230216002316 |
| Provider Name | Reginald Keith Riggins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649818550 PECOS PAC ID: 7719391622 Enrollment ID: I20230217001014 |
Samaritan Counseling Centers Of The U.p. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 117 W Genesee St, Suite 9, Iron River, MI 49935 Phone: 906-265-2000 | |
Northpointe Behavioral Healthcare Systems Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 703 N 2nd Ave, Iron River, MI 49935 Phone: 906-774-0522 | |
Supportive Care I Of Michigan Pc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 330 Lincoln Ave, Iron River, MI 49935 Phone: 718-506-1115 |