Provider Demographics
NPI:1063998102
Name:THERAPY STORES, LLC
Entity type:Organization
Organization Name:THERAPY STORES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-986-5941
Mailing Address - Street 1:1350 CONNECTICUT AVE NW STE 800
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-1733
Mailing Address - Country:US
Mailing Address - Phone:202-986-5941
Mailing Address - Fax:
Practice Address - Street 1:115 BROADWAY STE 1800
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1652
Practice Address - Country:US
Practice Address - Phone:212-234-6167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty