Organization
CEDAR CENTRE PSYCHIATRIC GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN NETOLICKY M.D. (PARTNER)
(319) 365-3993
Entity
Organization
Contact information
Practice address
1730 1ST AVE NE, CEDAR RAPIDS, IA 52402-5433
(319) 365-3993
(319) 364-0116
Mailing address
PO BOX 1408, CEDAR RAPIDS, IA 52406-1408
(319) 365-3993
(319) 364-0116
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
IA
103T00000X
Psychologist
—
IA
103TC1900X
Counseling Psychologist
—
IA
1041C0700X
Clinical Social Worker
—
IA
2084P0800X
Psychiatry Physician
Primary
—
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0174151
—
IA
01
—
17415
WELLMARK BC/BS
IA
Enumeration date
03/03/2006
Last updated
02/25/2016
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