# MEDITELECARE OF WASHINGTON PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659096089
- **Authorized official:** TERESA P TROJANOWSKI (DIRECTOR OF REVENUE CYCLE)
- **Authorized official phone:** (860) 788-6404

## Contact information

- **Practice address:** 300 DESCHUTES WAY SW STE 208, TUMWATER, WA 98501-7719
- **Practice address phone:** (860) 788-6404
- **Practice address fax:** (860) 829-0495
- **Mailing address:** 213 COURT ST FL 6, MIDDLETOWN, CT 06457-3346
- **Mailing address phone:** (860) 788-6404
- **Mailing address fax:** (860) 829-0495

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 2084P0805X | Geriatric Psychiatry Physician | — | NULL | — |
| 2084P0805X | Geriatric Psychiatry Physician | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/07/2022
- **Last updated:** 10/07/2022