Provider Demographics
NPI:1316692114
Name:MDM THERAPY AND CONSULTING SERVICES, LLC
Entity type:Organization
Organization Name:MDM THERAPY AND CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HORWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, CAADC, CCS
Authorized Official - Phone:215-354-7700
Mailing Address - Street 1:355 BRIDGETOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7206
Mailing Address - Country:US
Mailing Address - Phone:215-354-7700
Mailing Address - Fax:
Practice Address - Street 1:82 BUCK RD STE 2
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:18966-1751
Practice Address - Country:US
Practice Address - Phone:215-354-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013376326OtherNPI