Provider Demographics
NPI:1578786174
Name:PSYSCAPE PLLC
Entity Type:Organization
Organization Name:PSYSCAPE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VECCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-552-9832
Mailing Address - Street 1:447 POPLAR FORK RD
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9788
Mailing Address - Country:US
Mailing Address - Phone:304-552-9832
Mailing Address - Fax:866-212-0708
Practice Address - Street 1:201 6TH AVE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2836
Practice Address - Country:US
Practice Address - Phone:304-552-9832
Practice Address - Fax:866-212-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV647103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0164492000Medicaid