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Eugene Albert Modell

Psychologist

Behavioral Health & Social Service Providers

1601 Carmen Dr, Ste 211, Camarillo, CA 93010-3103

PECOS Enrollment

This provider is enrolled in PECOS as EUGENE MODELL.

Based on the most recent information from CMS, provider Eugene Albert Modell is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 11:51 AM.

Profile Details

Provider ID
1699859926
Provider Type
Individual
Full Name
Modell, Eugene Albert
Title
Dr.
Credential
PH.D.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
10/24/2006
Last Updated
10/26/2016

Contact Information

Practice Location

1601 Carmen Dr, Ste 211, Camarillo, CA 93010-3103

(805) 987-3727

(805) 484-0356

Mailing Location

1601 Carmen Dr, Ste 211, Camarillo, CA 93010-3103

(805) 987-3727

(805) 484-0356

Provider Taxonomies

Code	Description	License
Code 103TC0700X Primary	Description Psychologist Behavioral Health & Social Service Providers	License PSY 5021 California

Eugene Albert Modell

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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