| Dr Kyle David Raque, PSYD | |
|
9757 Blue Ridge Dr, Blue Ridge, GA 30513-4167 | |
| (706) 455-2490 | |
| Not Available |
| Full Name | Dr Kyle David Raque |
|---|---|
| Gender | Male |
| Speciality | Clinical Psychologist |
| Experience | 21 Years |
| Location | 9757 Blue Ridge Dr, Blue Ridge, Georgia |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790863900 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY003039 (Georgia) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Blue Ridge Psychological Services, Llc | 1759428063 | 2 |
| Entity Name | Blue Ridge Psychological Services, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1750524781 PECOS PAC ID: 1759428063 Enrollment ID: O20091019000599 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Kyle David Raque, PSYD 9757 Blue Ridge Dr, Blue Ridge, GA 30513-4167 Ph: (706) 455-2490 | Dr Kyle David Raque, PSYD 9757 Blue Ridge Dr, Blue Ridge, GA 30513-4167 Ph: (706) 455-2490 |
Esther Jean-gratia, PSYD Psychologist Medicare: Medicare Enrolled Practice Location: 9757 Blue Ridge Dr, Blue Ridge, GA 30513 Phone: 706-455-2490 | |
Dr. Alvin Ronald Seifert, PHD Psychologist Medicare: Medicare Enrolled Practice Location: 9757 Blue Ridge Dr, Blue Ridge, GA 30513 Phone: 706-455-2490 Fax: 706-946-6574 | |
Willa Boston, PSYD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 9757 Blue Ridge Dr, Blue Ridge, GA 30513 Phone: 706-455-2490 Fax: 706-946-6574 | |
Dr. Kenneth Bradford Carpenter, PSYD Psychologist Medicare: Accepting Medicare Assignments Practice Location: 165 Blue Ridge Overlook, Blue Ridge, GA 30513 Phone: 706-946-4647 Fax: 706-374-5006 |