Jon Petruschke Llc - Medicare Mental Health Clinic in Portland, ME

Jon Petruschke Llc is a medicare enrolled mental health clinic (Social Worker - Clinical) in Portland, Maine. The current practice location for Jon Petruschke Llc is 145 Newbury St, Suite 2, Portland, Maine. For appointments, you can reach them via phone at (207) 774-9667. The mailing address for Jon Petruschke Llc is 21 Howard St, Portland, Maine and phone number is (207) 774-9667.

Jon Petruschke Llc is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1528593985. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (207) 774-9667.

Contact Information

Jon Petruschke Llc
145 Newbury St
Suite 2
Portland
ME 04101-4261
(207) 774-9667
Not Available

Mental Health Clinic Profile

Full NameJon Petruschke Llc
SpecialitySocial Worker
Location145 Newbury St, Portland, Maine
Authorized Official Name and PositionJon Petruschke (SOCIAL WORKER)
Authorized Official Contact2077749667
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Jon Petruschke Llc
21 Howard St
Portland
ME 04101-3208

Ph: (207) 774-9667
Jon Petruschke Llc
145 Newbury St
Suite 2
Portland
ME 04101-4261

Ph: (207) 774-9667

NPI Details:

NPI Number1528593985
Provider Enumeration Date04/24/2017
Last Update Date04/24/2017

Medicare PECOS Information:

Medicare PECOS PAC ID4688941164
Medicare Enrollment IDO20170605001992

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Medical Identifiers

Medical identifiers for Jon Petruschke Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1528593985NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
1041C0700XSocial Worker - Clinical (* (Not Available))Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Jon Petruschke Llc acts as a billing entity for following providers:
Provider NameJon Petruschke
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1306021910
PECOS PAC ID: 5597032078
Enrollment ID: I20170605002099

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