Modern Psych and Wellness PLLC
NPI 1104674621ActiveOrganization· Psychologist· Taylor, MI
Psychologist in Taylor, Michigan, registered in NPPES in May 2024. The authorized official on file is Rana Succurro, MD, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1104674621 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 9, 2024 |
| Last updated in NPPES | Mar 18, 2025 |
| Certified by provider | Mar 18, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist Primary | 103T00000X | — | — |
| Psychologist, Addiction (Substance Use Disorder) | 103TA0400X | — | — |
| Internal Medicine | 207R00000X | — | — |
| Psychiatry & Neurology, Psychiatry | 2084P0800X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (MI) |
|---|
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