Provider Demographics
NPI:1720628969
Name:PSYCHOTHERAPY SERVICES LLC
Entity type:Organization
Organization Name:PSYCHOTHERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETORSHIP/PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:G
Authorized Official - Last Name:LIZCANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-494-0333
Mailing Address - Street 1:207 ROCK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3749
Mailing Address - Country:US
Mailing Address - Phone:203-494-0333
Mailing Address - Fax:203-494-0333
Practice Address - Street 1:904 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3921
Practice Address - Country:US
Practice Address - Phone:203-494-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty