Provider Demographics
NPI:1427083583
Name:PSYCHOTHERAPEUTIC COMMUNITY SERVICES, INC
Entity type:Organization
Organization Name:PSYCHOTHERAPEUTIC COMMUNITY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:410-778-9114
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:SUITE I
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-0690
Mailing Address - Country:US
Mailing Address - Phone:410-778-9114
Mailing Address - Fax:410-778-7988
Practice Address - Street 1:630 W DIVISION ST
Practice Address - Street 2:SUITE F
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2760
Practice Address - Country:US
Practice Address - Phone:302-674-3366
Practice Address - Fax:302-674-3360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE103TP2701X103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000930161Medicaid
DE0000930161Medicaid