Provider Demographics
NPI:1285281444
Name:EMPOWERED THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:EMPOWERED THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:CERRITOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-956-0768
Mailing Address - Street 1:22 IVY OAK CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3844
Mailing Address - Country:US
Mailing Address - Phone:301-956-0768
Mailing Address - Fax:
Practice Address - Street 1:16650 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2418
Practice Address - Country:US
Practice Address - Phone:240-720-7167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty