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Organization
VERICARE OF CALIFORNIA MEDICAL GROUP
Active
Organization
VERICARE OF CALIFORNIA MEDICAL GROUP
Active
Other names
Vericare
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA KING (DIRECTOR, CREDENTIALING ENROLLMENT)
(800) 370-3651
Entity
Organization
Contact information
Practice address
205 GRANADA ST, CAMARILLO, CA 93010-7715
(800) 257-8715
(800) 819-1655
Mailing address
55 HATCHETTS HILL RD, OLD LYME, CT 06371-1534
(800) 370-3651
(877) 515-7147
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CH5753
RAILROAD MEDICARE
CA
05
—
GPS000150
—
CA
Enumeration date
05/23/2006
Last updated
07/11/2017
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