| Supportive Care Of South Carolina Llc | |
|
734 York St Mt Pleasant SC 29464-2615 | |
| (718) 298-4375 | |
| Not Available |
| Full Name | Supportive Care Of South Carolina Llc |
|---|---|
| Speciality | Psychologist |
| Location | 734 York St, Mt Pleasant, South Carolina |
| 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 South Carolina Llc 27 Randolph Rd Howell NJ 07731-8611 Ph: (718) 298-4375 | Supportive Care Of South Carolina Llc 734 York St Mt Pleasant SC 29464-2615 Ph: (718) 298-4375 |
| NPI Number | 1417681412 |
|---|---|
| Provider Enumeration Date | 07/14/2022 |
| Last Update Date | 07/14/2022 |
| Certification Date | 07/14/2022 |
| Medicare PECOS PAC ID | 7618352451 |
|---|---|
| Medicare Enrollment ID | O20220915001319 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417681412 | NPI | - | NPPES |
| Provider Name | Ryan Law Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417208091 PECOS PAC ID: 1052564523 Enrollment ID: I20130111000239 |
| Provider Name | Stacy L Joye |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043697642 PECOS PAC ID: 7416261136 Enrollment ID: I20150812006338 |
| Provider Name | Mary L Harding |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639557531 PECOS PAC ID: 3971819608 Enrollment ID: I20150826001232 |
| Provider Name | Douglas M Brandt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487742243 PECOS PAC ID: 5597845610 Enrollment ID: I20190410002778 |
| Provider Name | Brandi L Fowler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629623202 PECOS PAC ID: 8921433905 Enrollment ID: I20200122000157 |
| Provider Name | William Riley Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437696986 PECOS PAC ID: 1456782226 Enrollment ID: I20200511002510 |
| Provider Name | Elena Huttenlocher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194175992 PECOS PAC ID: 9436540093 Enrollment ID: I20211216000050 |
| Provider Name | Eleanor Tedesco |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700930914 PECOS PAC ID: 9638119308 Enrollment ID: I20220822001319 |
| Provider Name | Samuel A Wolde |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275173536 PECOS PAC ID: 9739503426 Enrollment ID: I20220927003418 |
| Provider Name | Rachel M Salerno |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1114235751 PECOS PAC ID: 0941215107 Enrollment ID: I20220927003624 |
| Provider Name | Deborah S Guidetti Gerwien |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821420563 PECOS PAC ID: 3173751492 Enrollment ID: I20221010000531 |
| Provider Name | Jorge Aguilar Zanatta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477704971 PECOS PAC ID: 9335396969 Enrollment ID: I20221013000575 |
| Provider Name | Osman Qureshi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942408265 PECOS PAC ID: 4082774286 Enrollment ID: I20221126000086 |
| Provider Name | Debra Gibson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861799694 PECOS PAC ID: 7517268022 Enrollment ID: I20230103002067 |
| Provider Name | Candace Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942913694 PECOS PAC ID: 3779953831 Enrollment ID: I20230105002497 |
| Provider Name | Eva Torres Maldonado |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164881736 PECOS PAC ID: 9032491022 Enrollment ID: I20230412002845 |
| Provider Name | Gilberto Pagan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1114021607 PECOS PAC ID: 1951710961 Enrollment ID: I20230412003131 |
| Provider Name | Zachary Stern |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609494749 PECOS PAC ID: 1153744198 Enrollment ID: I20230508002833 |
| Provider Name | Eboni Frazier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780130963 PECOS PAC ID: 9133586589 Enrollment ID: I20230531001035 |
| Provider Name | Elizabeth Mcgee Klixbull |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881027316 PECOS PAC ID: 2668831496 Enrollment ID: I20230711002479 |
| Provider Name | Andrew Seth Rosenzweig |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942203690 PECOS PAC ID: 9234043134 Enrollment ID: I20230823001989 |
| Provider Name | Mona Balooch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023294204 PECOS PAC ID: 3577914837 Enrollment ID: I20240110005158 |
| Provider Name | Anna A Borsic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801661079 PECOS PAC ID: 4284077017 Enrollment ID: I20240208003804 |
Mt. Pleasant Psychiatry Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 874 Whipple Rd Ste 200, Mt Pleasant, SC 29464 Phone: 843-400-4089 Fax: 877-832-2114 | |
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