Contact

Dr. Michele Iemolo
Embodied Heart Space

All evaluations require a completed referral from a licensed medical professional (e.g., PCP, psychologist, NP, etc.)

For clients with Medicaid (Presbyterian or BCBS) the referral MUST come from a medical professional who has an individual Medicaid Number. The Medicaid enrollment must belong to the individual practitioner (Type 1 NPI) rather than a generalized group or facility number (Type 2 NPI). Evaluations are conducted in English only for children 1.5 to 4.11 years old.

Evaluations are conducted in English only for children 18 months to 4 years 11 months old. We will only contact you after we receive this form.

Please have the provider complete the online form or download the referral form and fax (toll-free) to: 505-212-4412.