MEDICARE: MICAELA BATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810008349	VA

General Provider Information

NPI Number	:	1649857194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICAELA BATES

Provider Business Mailing Address
First Line	:	875 RIO EAST CT STE A
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-8050
Country	:	US
Telephone Number	:	502-457-1091
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 RIO EAST CT STE A
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-8050
Country	:	US
Telephone Number	:	502-202-4080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2021
Last Update Date	:	11/19/2023

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