| Systemic Psychotherapy, Llc | |
|
100 Melrose Ave Ste 103 Greenwich CT 06830-6277 | |
| (203) 970-4738 | |
| Not Available |
| Full Name | Systemic Psychotherapy, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 100 Melrose Ave Ste 103, Greenwich, Connecticut |
| Authorized Official Name and Position | Andrea De Ott (MANAGER) |
| Authorized Official Contact | 2033215379 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Systemic Psychotherapy, Llc 52 Lafayette Pl Apt 2e Greenwich CT 06830-5409 Ph: (203) 321-5379 | Systemic Psychotherapy, Llc 100 Melrose Ave Ste 103 Greenwich CT 06830-6277 Ph: (203) 970-4738 |
| NPI Number | 1205471307 |
|---|---|
| Provider Enumeration Date | 11/12/2019 |
| Last Update Date | 08/19/2020 |
| Certification Date | 08/19/2020 |
| Medicare PECOS PAC ID | 8729413901 |
|---|---|
| Medicare Enrollment ID | O20200116000138 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205471307 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Andrea De Ott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568746188 PECOS PAC ID: 2163761651 Enrollment ID: I20200116000233 |
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