Provider Demographics
NPI:1659096089
Name:MEDITELECARE OF WASHINGTON PLLC
Entity Type:Organization
Organization Name:MEDITELECARE OF WASHINGTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:P
Authorized Official - Last Name:TROJANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-788-6404
Mailing Address - Street 1:213 COURT ST FL 6
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3346
Mailing Address - Country:US
Mailing Address - Phone:860-788-6404
Mailing Address - Fax:860-829-0495
Practice Address - Street 1:300 DESCHUTES WAY SW STE 208
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-7719
Practice Address - Country:US
Practice Address - Phone:860-788-6404
Practice Address - Fax:860-829-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty