Provider Demographics
NPI:1386950327
Name:PSYCHOLOGICAL WORKS, LLC
Entity type:Organization
Organization Name:PSYCHOLOGICAL WORKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:540-230-5958
Mailing Address - Street 1:707 RANDOLPH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-2443
Mailing Address - Country:US
Mailing Address - Phone:540-230-5958
Mailing Address - Fax:540-552-0918
Practice Address - Street 1:707 RANDOLPH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-2443
Practice Address - Country:US
Practice Address - Phone:540-230-5958
Practice Address - Fax:540-633-3804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004007251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1528211901Medicaid