Provider Demographics
NPI:1063773836
Name:PSYCHOTHERAPEUTICS, INC.
Entity type:Organization
Organization Name:PSYCHOTHERAPEUTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERLICH PENCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD,LCSW
Authorized Official - Phone:201-833-9434
Mailing Address - Street 1:154 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5652
Mailing Address - Country:US
Mailing Address - Phone:201-833-9434
Mailing Address - Fax:201-833-4037
Practice Address - Street 1:154 BENNETT RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5652
Practice Address - Country:US
Practice Address - Phone:201-833-9434
Practice Address - Fax:201-833-4037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty