1760636013 NPI number — PSYCHOTHERAPEUTIC CHILDREN'S SERVICES

Table of content: (NPI 1760636013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760636013 NPI number — PSYCHOTHERAPEUTIC CHILDREN'S SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHOTHERAPEUTIC CHILDREN'S SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760636013
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
870 HIGH STREET
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
CHESTERTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-778-9114
Provider Business Mailing Address Fax Number:
410-778-7988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 W DIVISION STREET
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-672-7159
Provider Business Practice Location Address Fax Number:
302-672-7178
Provider Enumeration Date:
11/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
RANDALL
Authorized Official Middle Name:
LEWIS
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
410-778-9114

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , with the licence number:  106301 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1427083583 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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