Headway practice location details for CAQH

Updated

This guide provides instructions for all Headway providers on how to ensure the correct Headway practice location is listed and maintained in your CAQH ProView profile. Maintaining these locations is critical for credentialing and keeping your in-network status with our insurance partners.

 

Why you need to maintain the Headway practice location

For many of the insurance plans you are credentialed with through Headway, the payer uses your CAQH profile as the primary source of truth for your professional data.

  • Indicator of group affiliation: Payers view the presence of the Headway practice location (listed under Headway’s Tax ID) as the official indicator that you are actively practicing with the Headway group at that location in that specific state.
  • Risk of network termination: If you delete or archive the Headway practice location(s), the payer system interprets this as a signal that you are no longer practicing with the Headway group at that location. This action could trigger an involuntary network termination, removing you from the payer's network under Headway and preventing payment for services.

 

Find your state below and expand to view state-specific instructions. 

For providers credentialed in multiple states

If you're joining Headway in multiple states, with multiple licenses, you'll need to add practice locations for each respective license. 

Alabama

Personal information

Practice location

  • Practice location name: Headway Colorado Behavioral Health Services, Inc. 
  • Location address 
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 2100 SouthBridge Parkway, Suite 650
      • City: Birmingham
      • State: AL
      • Zip Code: 35209
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861747274
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1164014874
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Colorado Behavioral Health Services, Inc.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 671704
    • City: Dallas
    • State: TX
    • Zip Code: 75267-1704
    • Country: United States
Alaska

Personal information

Practice location

  • Practice location name: Headway Colorado Behavioral Health Services, Inc. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 721 Depot Drive
      • City: Anchorage
      • State: AK
      • Zip Code: 99501
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861747274
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1164014874
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Colorado Behavioral Health Services, Inc.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 671704
    • City: Dallas
    • State: TX
    • Zip Code: 75267-1704
    • Country: United States
Arizona

Personal information

Practice location

  • Practice location name: Headway Michigan Behavioral Health Services, P.C. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 2 North Central Ave Fl 18
      • City: Phoenix
      • State: AZ
      • Zip Code: 85004
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861826892
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1790377489
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Michigan Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675477
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5477
    • Country: United States
Arkansas

Personal information

Practice location

  • Practice location name: Headway Florida Behavioral Health Services, P.A. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 400 West Capitol Avenue, Suite 1700
      • City: Little Rock
      • State: AR
      • Zip Code: 72201
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 854252623
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1689260267
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Florida Behavioral Health Services, P.A.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 670296
    • City: Dallas
    • State: TX
    • Zip Code: 75267-0296
    • Country: United States
California

Personal information

Practice location

  • Practice location name: Headway California Behavioral Health Services, P.C. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 680 E Colorado Blvd Suite 180 & 2nd floor
      • City: Pasadena
      • State: CA
      • Zip Code: 91101
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 872475176
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1174292866
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Michigan Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675477
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5477
    • Country: United States
Colorado

Personal information

Practice location

  • Practice location name: Headway Colorado Behavioral Health Services, Inc. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 5445 DTC Parkway, Penthouse 4
      • City: Greenwood Village
      • State: CO
      • Zip Code: 80111
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861747274
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1164014874
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Colorado Behavioral Health Services, Inc.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 671704
    • City: Dallas
    • State: TX
    • Zip Code: 75267-1704
    • Country: United States
Connecticut

Personal information

Practice location

  • Practice location name: Headway New Jersey Behavioral Health Services, P.C. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 1000 Lafayette Blvd Suite 1100
      • City: Bridgeport
      • State: CT
      • Zip Code: 06604
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 873043970
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1629660337
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway New Jersey Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675475
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5475
    • Country: United States
Delaware

Personal information

Practice location

  • Practice location name: Headway New Jersey Behavioral Health Services, P.C. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 1000 N. West Street, Suite 1200
      • City: Wilmington
      • State: DE
      • Zip Code: 19801
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 873043970
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1629660337
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway New Jersey Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675475
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5475
    • Country: United States
Florida (standard)

Personal information

Practice location

  • Practice location name: Headway Florida Behavioral Health Services, P.A. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 11900 Biscayne Blvd, Suite 800
      • City: North Miami
      • State: FL
      • Zip Code: 33181
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 886425127
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1407620847
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Florida Behavioral Health Services, P.A.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 671704
    • City: Dallas
    • State: TX
    • Zip Code: 75267-1704
    • Country: United States
Florida (Florida Blue)

Personal information

Practice location

  • Practice location name: Sunshine Medical Behavioral Health Services, P.A. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 1110 Brickell Avenue, Suite 430
      • City: Miami
      • State: FL
      • Zip Code: 33131
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 990941647
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1437913456
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Florida Behavioral Health Services, P.A.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: 1110 Brickell Avenue, Suite 430
    • City: Miami
    • State: FL
    • Zip Code: 33131
    • Country: United States
Georgia

Personal information

Practice location

  • Practice location name: New York Medical Behavioral Health Services, P.C.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 715 Peachtree Street N.E. Suite 100 & 200
      • City: Atlanta 
      • State: GA
      • Zip Code: 30308
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 832675429
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1235600834
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: New York Medical Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675480
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5480
    • Country: United States
Hawaii

Personal information

Practice location

  • Practice location name: Headway Colorado Behavioral Health Services, Inc. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 500 Ala Moana Blvd, Suite 7400
      • City: Honolulu
      • State: HI
      • Zip Code: 96813
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861747274
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1164014874
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Colorado Behavioral Health Services, Inc.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 671704
    • City: Dallas
    • State: TX
    • Zip Code: 75267-1704
    • Country: United States
Idaho

Personal information

Practice location

  • Practice location name: Headway Colorado Behavioral Health Services, Inc. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 950 Bannock Street, Suite 1100, Boise, Idaho 83702
      • City: Boise
      • State: ID
      • Zip Code: 83702
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861747274
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1164014874
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Colorado Behavioral Health Services, Inc.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 671704
    • City: Dallas
    • State: TX
    • Zip Code: 75267-1704
    • Country: United States
Illinois

Personal information

Practice location

  • Practice location name: Headway Illinois Behavioral Health Services, PLLC 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 111 W. Jackson Suite 1700
      • City: Chicago
      • State: IL
      • Zip Code: 60604
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 862606724
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1811572589
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Illinois Behavioral Health Services, PLLC
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675471
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5471
    • Country: United States
Indiana

Personal information

Practice location

  • Practice location name: Headway Michigan Behavioral Health Services, P.C. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 3815 River Crossing Parkway, Suite 100
      • City: Indianapolis
      • State: IN
      • Zip Code: 46240
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861826692
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1790377489
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Michigan Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675477
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5477
    • Country: United States
Iowa

Personal information

Practice location

  • Practice location name: Headway Michigan Behavioral Health Services, P.C. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 699 Walnut Street, 4th Floor
      • City: Des Moines
      • State: IA
      • Zip Code: 50309
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861826692
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1790377489
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Michigan Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675477
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5477
    • Country: United States
Kansas

Personal information

Practice location

  • Practice location name: Headway Kansas Behavioral Health Services, P.A.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 801 E. Douglas Avenue, 2nd Floor
      • City: Wichita
      • State: KS
      • Zip Code: 67202
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 884345092
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1033820410
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Kansas Behavioral Health Services, P.A.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 671189
    • City: Dallas
    • State: TX
    • Zip Code: 75267-1189
    • Country: United States
Kentucky

Personal information

Practice location

  • Practice location name: Headway Florida Behavioral Health Services, P.A.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 312 S. Fourth Street, Suite 700
      • City: Louisville
      • State: KY
      • Zip Code: 40202
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 854252623
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1689260267
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Florida Behavioral Health Services, P.A.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 670296
    • City: Dallas
    • State: TX
    • Zip Code: 75267-0296
    • Country: United States
Louisiana

Personal information

Practice location

  • Practice location name: Headway Colorado Behavioral Health Services, Inc.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 650 Poydras Street Suite 1400
      • City: New Orleans
      • State: LA
      • Zip Code: 70130
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861747274
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1164014874
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Colorado Behavioral Health Services, Inc.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 671704
    • City: Dallas
    • State: TX
    • Zip Code: 75267-1704
    • Country: United States
Maine

Personal information

Practice location

  • Practice location name: Headway New Jersey Behavioral Health Services, P.C.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 63 Federal Street
      • City: Portland
      • State: ME
      • Zip Code: 04101
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 873043970
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1629660337
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway New Jersey Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675475
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5475
    • Country: United States
Maryland

Personal information

Practice location

  • Practice location name: New York Medical Behavioral Health Services, P.C.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 6701 Democracy Blvd Suite 300
      • City: Bethesda
      • State: MD
      • Zip Code: 20817
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 832675429
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1235600834
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: New York Medical Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675480
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5480
    • Country: United States
Massachussetts

Personal information

Practice location

  • Practice location name: Headway New Jersey Behavioral Health Services, P.C.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 100 Cambridge Street 14th Floor
      • City: Boston
      • State: MA
      • Zip Code: 02114
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 873043970
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1629660337
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway New Jersey Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675475
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5475
    • Country: United States
Michigan

Personal information

Practice location

  • Practice location name: Headway Michigan Behavioral Health Services, P.C.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 3200 Greenfield Road Suite 300
      • City: Dearborn
      • State: MI
      • Zip Code: 48120
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861826692
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1790377489
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Michigan Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675477
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5477
    • Country: United States
Minnesota

Personal information

Practice location

  • Practice location name: Headway Michigan Behavioral Health Services, P.C.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 445 Minnesota Street, Suite 1500
      • City: St. Paul
      • State: MN
      • Zip Code: 55101
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861826692
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1790377489
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Michigan Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675477
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5477
    • Country: United States
Mississippi

Personal information

Practice location

  • Practice location name: Headway Colorado Behavioral Health Services, Inc.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 232 Market Street
      • City: Flowood
      • State: MS
      • Zip Code: 39232
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861747274
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1164014874
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Colorado Behavioral Health Services, Inc.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 671704
    • City: Dallas
    • State: TX
    • Zip Code: 75267-1704
    • Country: United States
Missouri

Personal information

Practice location

  • Practice location name: Headway Michigan Behavioral Health Services, P.C.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 7280 N.W. 87th Terrace, Suite C-210
      • City: Kansas City
      • State: MO
      • Zip Code: 64153
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861826692
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1790377489
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Michigan Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675477
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5477
    • Country: United States
Montana

Personal information

Practice location

  • Practice location name: Headway Michigan Behavioral Health Services, P.C. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 5 West Mendenhall Street Suite 202
      • City: Bozeman
      • State: MT
      • Zip Code: 59715
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861826692
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1790377489
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Michigan Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675477
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5477
    • Country: United States
Nebraska

Personal information

Practice location

  • Practice location name: Headway Florida Behavioral Health Services, P.A.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 71299 Farnam Street, Suite 300
      • City: Omaha
      • State: NE
      • Zip Code: 68102
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 854252623
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1689260267
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Florida Behavioral Health Services, P.A.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 670296
    • City: Dallas
    • State: TX
    • Zip Code: 75267-0296
    • Country: United States
Nevada

Personal information

Practice location

  • Practice location name: Headway California Behavioral Health Services, P.C. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 2300 West Sahara Avenue, Suite 800
      • City: Las Vegas
      • State: NV
      • Zip Code: 89102
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 872475176
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1174292866
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway California Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 8620
    • City: Pasadena
    • State: CA
    • Zip Code: 91109-8608
    • Country: United States
New Hampshire

Personal information

Practice location

  • Practice location name: Headway New Jersey Behavioral Health Services, P.C. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 15 Constitution Drive, 1st Floor
      • City: Bedford
      • State: NH
      • Zip Code: 03110
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 873043970
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1629660337
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway New Jersey Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675475
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5475
    • Country: United States
New Jersey

Personal information

Practice location

  • Practice location name: Headway New Jersey Behavioral Health Services, P.C. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 221 River Street, 9th Floor
      • City: Hoboken
      • State: NJ
      • Zip Code: 07030
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 873043970
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1629660337
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway New Jersey Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675475
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5475
    • Country: United States
New Mexico

Personal information

Practice location

  • Practice location name: Headway Colorado Behavioral Health Services, Inc. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 500 Marquette Avenue NW, Suite 1200
      • City: Albuquerque
      • State: NM
      • Zip Code: 87102
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861747274
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1164014874
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Colorado Behavioral Health Services, Inc.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 671704
    • City: Dallas
    • State: TX
    • Zip Code: 75267-1704
    • Country: United States
New York

Personal information

Practice location

  • Practice location name: New York Medical Behavioral Health Services, P.C. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 620 8th Avenue
      • City: New York
      • State: NY
      • Zip Code: 10018
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 832675429
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1235600834
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: New York Medical Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675477
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5477
    • Country: United States
North Carolina 

Personal information

Practice location

  • Practice location name: New York Medical Behavioral Health Services, P.C.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 8601 Six Forks Road Suite 400
      • City: Raleigh 
      • State: NC
      • Zip Code: 27615
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 832675429
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1235600834
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: New York Medical Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675480
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5480
    • Country: United States
North Dakota

Personal information

Practice location

  • Practice location name: Headway Michigan Behavioral Health Services, P.C. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 1531 32nd Ave. S., Suite 102
      • City: Fargo
      • State: ND
      • Zip Code: 58103
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861826692
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1790377489
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Michigan Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675477
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5477
    • Country: United States
Ohio

Personal information

Practice location

  • Practice location name: Headway Colorado Behavioral Health Services, Inc. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 600 Superior Ave. East Fifth Third Building Suite 1300
      • City: Cleveland
      • State: OH
      • Zip Code: 44114
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861747274
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1164014874
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Colorado Behavioral Health Services, Inc.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 671704
    • City: Dallas
    • State: TX
    • Zip Code: 75267-1704
    • Country: United States
Oklahoma

Personal information

Practice location

  • Practice location name: Headway Florida Behavioral Health Services, P.A.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 101 Park Avenue Suite 1300
      • City: Oklahoma City
      • State: OK
      • Zip Code: 73102
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 854252623
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1689260267
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Florida Behavioral Health Services, P.A.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675480
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5480
    • Country: United States
Oregon

Personal information

Practice location

  • Practice location name: New York Medical Behavioral Health Services, P.C. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 10260 SW Greenberg Road FL 4
      • City: Portland
      • State: OR
      • Zip Code: 97223
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 832675429
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1235600834
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: New York Medical Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675480
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5480
    • Country: United States
Pennsylvania

Personal information

Practice location

  • Practice location name: Headway Michigan Behavioral Health Services, P.C.
  • Location address
    • If you have an office in PA where you see patients in-person face-to-face, list your office address. If you do not have an office for in-person visits AND you live in Philadelphia, please list the address below.
      • Street 1: 1626 Locust Street
      • City: Philadelphia
      • State: PA
      • Zip Code: 19103
      • Country: United States
    • If you have an office in PA where you see patients in-person face-to-face, list your office address. If you do not have an office for in-person visits AND you DON’T live in Philadelphia, please list the address below.
      • Street 1: 322 North Shore Drive, Building 1B, Suite 200
      • City: Pittsburgh
      • State: PA
      • Zip Code: 15212
      • Country: United States
    • If you have an office in PA where you see patients in-person face-to-face, list your office address. If you do not have an office for in-person visits AND you DON’T live in Philadelphia, please list the address below.
      • Street 1: 2713 Embassy Drive, Lancaster PA, 17063
      • City: Lancaster
      • State: PA
      • Zip Code: 17063
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861826692
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1790377489
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Michigan Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675477
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5477
    • Country: United States
Rhode Island

Personal information

Practice location

  • Practice location name: Headway New Jersey Behavioral Health Services, P.C.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 10 Dorrance Street, Suite 700
      • City: Providence
      • State: RI
      • Zip Code: 02903
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 873043970
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1629660337
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway New Jersey Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675475
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5475
    • Country: United States
South Carolina

Personal information

Practice location

  • Practice location name: New York Medical Behavioral Health Services, P.C.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 4000 S. Faber Place Drive, Suite 300
      • City: Charleston
      • State: SC
      • Zip Code: 29405
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 832675429
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1235600834
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: New York Medical Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675480
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5480
    • Country: United States
South Dakota

Personal information

Practice location

  • Practice location name: Headway Colorado Behavioral Health Services, Inc. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 101 S. Reid Street, Suite 307
      • City: Sioux Falls
      • State: SD
      • Zip Code: 57103
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861747274
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1164014874
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Colorado Behavioral Health Services, Inc.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 671704
    • City: Dallas
    • State: TX
    • Zip Code: 75267-1704
    • Country: United States
Tennessee

Personal information

Practice location

  • Practice location name: Headway Florida Behavioral Health Services, P.A.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 40 Burton Hills Boulevard Suite 200
      • City: Nashville
      • State: TN
      • Zip Code: 37215
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 854252623
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1689260267
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Florida Behavioral Health Services, P.A.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 670296
    • City: Dallas
    • State: TX
    • Zip Code: 75267-0296
    • Country: United States
Texas

Personal information

Practice location

  • Practice location name: Headway Texas Behavioral Health Services, P.A. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 8700 Crownhill Blvd, Suite 201
      • City: San Antonio
      • State: TX
      • Zip Code: 78209
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 871847392
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1235600834
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Texas Behavioral Health Services, P.A.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 671704
    • City: Dallas
    • State: TX
    • Zip Code: 75267-1704
    • Country: United States
Utah

Personal information

Practice location

  • Practice location name: Headway Colorado Behavioral Health Services, Inc. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 2825 E Cottonwood Parkway, Suite 500
      • City: Salt Lake City
      • State: UT
      • Zip Code: 84121
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 861747274
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1164014874
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Colorado Behavioral Health Services, Inc.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 671704
    • City: Dallas
    • State: TX
    • Zip Code: 75267-1704
    • Country: United States
Vermont

Personal information

Practice location

  • Practice location name: Headway New Jersey Behavioral Health Services, P.C.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 1 Lawson Lane Suite 200D
      • City: Burlington
      • State: VT
      • Zip Code: 05401
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 873043970
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1629660337
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway New Jersey Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675475
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5475
    • Country: United States
Virginia

Personal information

Practice location

  • Practice location name: New York Medical Behavioral Health Services, P.C.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 12020 Sunrise Valley Drive, Suite 100
      • City: Reston
      • State: VA
      • Zip Code: 20191
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 832675429
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1235600834
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: New York Medical Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675480
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5480
    • Country: United States
Washington

Personal information

Practice location

  • Practice location name: New York Medical Behavioral Health Services, P.C. 
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 1455 NW Leary Way Suite 400
      • City: Seattle
      • State: WA
      • Zip Code: 98107
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 832675429
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1235600834
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: New York Medical Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675480
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5480
    • Country: United States
West Virginia

Personal information

Practice location

  • Practice location name: Headway Florida Behavioral Health Services, P.A.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 204 8th Street
      • City: Marlinton
      • State: WV
      • Zip Code: 24954
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 854252623
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1689260267
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Florida Behavioral Health Services, P.A.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: P.O. BOX 670296
    • City: Dallas
    • State: TX
    • Zip Code: 75267-0296
    • Country: United States
Wisconsin

Personal information

Practice location

  • Practice location name: Headway Wisconsin Behavioral Health Services, S.C.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 1433 N Water Street, Fl 4
      • City: Milwaukee
      • State: WI
      • Zip Code: 53202
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 884186963
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1437875564
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway Wisconsin Behavioral Health Services, S.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675482
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5482
    • Country: United States
Wyoming

Personal information

Practice location

  • Practice location name: Headway California Behavioral Health Services, P.C. 
  • Location address
    • If you have an office in WY where you see patients in-person face-to-face, list your office address under "Location Address." If you do not have an office for in-person visits, check off "This is a virtual-only location" under the "Virtual-only Location" section.
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 872475176
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1174292866
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: Headway California Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 8620
    • City: Pasadena
    • State: CA
    • Zip Code: 91109-8608
    • Country: United States
Washington D.C.

Personal information

Practice location

  • Practice location name: New York Medical Behavioral Health Services, P.C.
  • Location address
    • If you provide virtual-only care to Headway clients in a state: Please use the address listed below. Headway uses a dedicated administrative address as your practice location. Since you do not physically practice there, you may not recognize the address—this is expected. Do not remove or archive this location.
    • If you provide in-person care to Headway clients: Please list your office address. This address should match with the address you have on Sigmund.
      • Street 1: 1200 G Street, NW Suite 800
      • City: Washington, D.C
      • State: DC
      • Zip Code: 20005
      • Country: United States
  • Phone numbers 
    • Appointment Phone Number: 646-941-7645
    • Fax Number: 929-596-7897
  • Business identifiers 
    • Tax ID: 832675429
    • Type of Tax ID?: Group
    • Organization (Type 2) NPI: 1235600834
    • Type of Practice: Group
       

Provider at the location

  • Affiliation
    • Please describe your affiliation with this location: I see patients by appointment at least one day per week on a regular basis.
    • Provider's Start Date: [Date you are filling out CAQH]
  • Patients 
    • Is this your primary practice?
      • If you have an existing primary practice in your account, select "No"
      • If you do not have an existing primary practice in your account, select "Yes"
    • Do you accept all new patients at this location?: Yes
    • Do you accept new patients at this practice location?: Yes
    • Do you accept existing patients with change of payor at this location?: Yes
    • Do you accept new Medicare patients at this location?: No
    • Do you accept new Medicaid patients at this location?: No
    • Do you accept new patients from physician referrals (i.e., referring letter) at this location?: Yes
    • Does the above information vary by health plan?: No
       

Services and resources

  • Telehealth
    • I provide telehealth services [checkbox]: Check if you provide telehealth services
    • Do you use a telehealth application or platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA)?: Yes (you must use a HIPAA compliant application to provide telehealth services through Headway)
  • Payment and Remittance
    • Check Payable To: New York Medical Behavioral Health Services, P.C.
    • Billing Policies
      • This practice offers Electronic Billing [checkbox]: Check
      • The office manager and payee contact are the same person [checkbox]: Check
  • Office personnel 
    • Office Manager/Business Staff Contact - First Name: Mehek
    • Office Manager/Business Staff Contact - Last Name: Punatar
    • Office Manager/Business Staff Contact - Phone Number: 646-453-6777
    • Office Manager/Business Staff Contact - Fax Number: 929-596-7897
    • Office Manager/Business Staff Contact - Email Address: payers@headway.co
    • The office manager is also the credentialing contact [checkbox]: Check
    • The office manager and billing contact are same [checkbox]: Check
  • Mailing address
    • Street 1: PO BOX 675480
    • City: Detroit
    • State: MI
    • Zip Code: 48267-5480
    • Country: United States

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