Provider Demographics
NPI:1124471115
Name:PSYCHOTHERAPEUTIC SERVICES, INC.
Entity type:Organization
Organization Name:PSYCHOTHERAPEUTIC SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-778-1099
Mailing Address - Street 1:983 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3447
Mailing Address - Country:US
Mailing Address - Phone:302-492-7400
Mailing Address - Fax:302-736-6004
Practice Address - Street 1:983 FOREST ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3447
Practice Address - Country:US
Practice Address - Phone:302-492-7400
Practice Address - Fax:302-736-6004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSYCHOTHERAPEUTIC CHILDREN'S SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-14
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1180967320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities