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The PCSS is designed to assist physicians incorporate the use of buprenorphine for prescription opioid and heroin dependent patients into their practices. The PCSS service is available, at no cost, to interested physicians and staff. The essential elements of the PCSS are a national network of trained physician mentors with expertise in buprenorphine treatment and skilled in clinical education, who can provide support by phone or email. If you would like to receive support from the PCSS, please complete and submit this electronic form.

You may also download a copy of the registration form. Once completed, please email or fax it to PCSSproject@asam.org, fax: 301-576-5156, or call the PCSS toll-free line 1-877-630-8812 for further information.

1. First name:

2. Last name:

3. Email address:

4. Phone number:

5. Do you have a particular mentor you wish to work with?
(See below for a full list of PCSS Mentors, their specialties and locations.)

     choose mentor :

Mentor Specialty Location
Patrick Abbott, MD Psychiatry Albuquerque, NM
Michael Alexandrov, MD Addiction Medicine, Psychiatry Guilderland, NY
Dan Alford, MD Internal Medicine Boston, MA
Charles Alpert, MD PM & R, Pain & Addiction Medicine Jenkintown, PA
David Battista, MD Addiction Medicine, Family Medicine Somerset, PA
Jeffery Baxter, MD, ASAM Family Medicine Worcester, MA
Louis Baxter, MD, FASAM Addiction Medicine Lawrenceville, NJ
Jeffery Berman, MD, FASAM Addiction Medicine, Addiction Psychiatry New Brunswick, NJ
James Berry, MD Family Medicine Corinna, ME
Joshua Boverman, MD Psychiatry Portland, OR
John Brooklyn, MD Addiction Medicine, Family Medicine Burlington, VT
Michael Carnevale, DO Internal Medicine Ukiah, CA
Carl Christensen, MD, PhD, MRO Addiction Medicine, OB Gyn Ypsilanti, MI
Sam Cullison, MD Family Medicine Seattle, WA
Scott Davis, MD, MA Addiction Medicine Rancho Mirage, CA
Thomas Deal, MD, PhD Addiction Medicine Seattle, WA
Anthony Dekker, DO Addiction Medicine Phoenix, AZ
Tim Derstine, MD, FASAM Psychiatry State College, PA
Michael Deshields, MD Addiction Medicine, Internal Medicine Blackwood, NJ
Bill Dickinson, DO Addiction Medicine, Family Medicine Everett, WA
Martin Doot, MD Family Medicine Des Plaines, IL
Stan Evans, MD Addiction Medicine Westbrook, ME
Ayman Fareed, MD Addiction Psychiatry Decatur, GA
James Finch, MD Family Medicine Durham, NC
Michael Fingerhood, MD Internal Medicine Baltimore, MD
Walter Fitzhugh, MD Psychiatry Lincoln, RI
Timothy Fong, MD Psychiatry Los Angeles, CA
John Franklin, MD Psychiatry Chicago, IL
Peter Friedmann, MD, MPH Addiction Medicine, Internal Medicine Providence, RI
Devang Gandhi, MD Addiction Medicine, Addiction Psychiatry Baltimore, MD
Vamsi Garlapati, MD Addiction Psychiatry, Psychiatry North Chicago, IL
Ivor Garlick, MD Addiction Medicine, Internal Medicine Denver, CO
Cynthia Geppert, MD, PhD Addiction Medicine, Psychiatry, Psychosomatic Medicine Albuquerque, NM
Phillip Gianelli, MD Psychiatry Metro NY (Nassau County)
Paul Gianutsos, MD, MPH Family Medicine Seattle, WA
Kenneth Gibson, DO Addiction Medicine Hulbert, OK
Angel Gonzales, MD Internal Medicine San Juan, PR
Adam Gordon, MD, MPH Addiction Medicine, Internal Medicine Pittsburgh, PA
Erik Gunderson, MD Addiction Medicine, Internal Medicine New York, NY
Gary Helmbrecht, MD Addiction Medicine, Maternal/Fetal Medicine Charlottesville, VA 
Charles Herndon, MD Internal Medicine Anchorage, AK
John Hopper, MD Internal Medicine, Pediatrics Detroit, MI
Terry Horton, MD Internal Medicine Long Island City, NY
Elizabeth Howell, MD Addiction Medicine, Addiction Psychiatry, Psychiatry Salt Lake City, UT
Mark Jorrisch, MD Addiction Medicine, Psychiatry Louisville, KY
Miriam Komaromy, MD Addiction Medicine, Internal Medicine Albuquerque, NM
Mark Kraus, MD, FASAM Addiction Medicine, Internal Medicine Waterbury, CT
Kevin Kunz, MD Addiction Medicine Kailua-Kona, HI
Stephen Lamb, MD Psychiatry Lexington, KY
Petros Levounis, MD Psychiatry New York, NY
Lance Longo, MD, FASAM Psychiatry Milwaukee, WI
David McDowell, MD, PhD Psychiatry New York, NY
David McDuff, MD Psychiatry Ellicott City, MD
Laura McNicholas, MD, PhD Addiction Psychiatry Philadelphia, PA
Robert Maslansky, MD Internal Medicine New York, NY
John Mendelson, MD Internal Medicine San Francisco, CA
Joseph Merrill, MD Internal Medicine Seattle, WA
Jennifer Michaels, MD Psychiatry Pittsfield, MA
Robert Mick, MD Addiction Medicine, Addiction Psychiatry Rochester, NY
Eric Morse, MD Addiction & Sport Psychiatry Raleigh, MD
Patrick O'Connor, MD Internal Medicine New Haven, CT
Ted Parran, MD Internal Medicine Cleveland, OH
Kevin Passer, MD Psychiatry (Child, Adolescent, Adult) Hattiesburg, MS
Ashwin Patkar, MD Psychiatry Durham, NC
Mark Publicker, MD Addiction Medicine Westbrook, ME
Darius Rastegar, MD Internal Medicine Baltimore, MD
Jack Resnik, MD Addiction Medicine, Internal Medicine Rochester, NY
Thomas Riordan, MD Addiction Medicine, Psychiatry Bryn Mawr, PA
Edwin Salsitz, MD Internal Medicine New York, NY
Stacy Seikel, MD Addiction Medicine, Anesthesiology Orlando, FL
Hayden Severin, MD Addiction Medicine Minneapolis, MN
Michael Sheehan, MD Psychiatry Tampa, FL
J. Mitchell Simson, MD Addiction Medicine, Internal Medicine Albuquerque, NM
Janet Soeffing, MD Internal Medicine Baltimore, MD
Richard Soper, MD, JD, MS Addiction Medicine, Psychiatry Nashville, TN
Susan Stine, MD Psychiatry Detroit, MI
Ravi Srivastava, MD Addiction Medicine, Psychiatry Hilton Head, SC
Geetha Subramaniam, MD Addiction Psychiatry, Child and Adolescent Psychiatry Baltimore, MD
Paul Tisher, MD Psychiatry Bangor, ME
John Verdon, MD Addiction Medicine, Psychiatry Shrewsbury, NJ
Sidarth Wakhlu, MD Addiction Medicine, Psychiatry Dallas/Ft. Worth, TX
Alan Wartenberg, MD, FACP, FASAM Addiction Medicine, Internal Medicine N. Kingston, RI
Christopher Welsh, MD Psychiatry Baltimore, MD
Susan Whitley, MD Family Medicine, Psychiatry Bronx, NY
Martha Wunsch, MD, FASAM Addiction Medicine, Pediatrics Blacksburg, VA




6. What city and state do you practice in?


7. What is your ZIP code?


8. What is your specialty?


9. Do you prefer a mentor with your same specialty even if that person is out of state (note: N/A if you've already chosen a mentor from the list above)?


10. What is your practice setting (e.g. private, clinic, academic, HMO, specialty addiction)?


11. How did you hear about the PCSS (e.g. Buprenorphine course, website, article, brochure):




You may also download a copy of the registration form. Once completed, please email or fax it to PCSSproject@asam.org, fax: 301-576-5156, or call the PCSS toll-free line 1-877-630-8812 for further information.

 

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