Provider Demographics
NPI:1356336903
Name:PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC
Entity type:Organization
Organization Name:PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:ZAPPIA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MA, NCC, LPC
Authorized Official - Phone:304-399-7760
Mailing Address - Street 1:99 CRACKER BARREL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1650
Mailing Address - Country:US
Mailing Address - Phone:304-525-7851
Mailing Address - Fax:304-697-1251
Practice Address - Street 1:99 CRACKER BARREL DR STE 100
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1650
Practice Address - Country:US
Practice Address - Phone:304-525-7851
Practice Address - Fax:304-697-1251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV288251S00000X
WV289273R00000X
WV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0991575Medicaid
WV3810022070OtherBHHF
WV0005355002Medicaid
WV001703803OtherBCBS CRU 273R0000X
WVBP00944410OtherLICENSE
WV001703804OtherBCBS OUTPATIENT
WV9122432Medicare PIN
WV001703803OtherBCBS CRU 273R0000X