Provider Demographics
NPI:1992802649
Name:PSYCHOTHERAPY SERVICES OF CT, LLC
Entity type:Organization
Organization Name:PSYCHOTHERAPY SERVICES OF CT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-647-8995
Mailing Address - Street 1:45 HARTFORD TURNPIKE
Mailing Address - Street 2:STE 2
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5274
Mailing Address - Country:US
Mailing Address - Phone:860-647-8995
Mailing Address - Fax:860-647-6930
Practice Address - Street 1:45 HARTFORD TURNPIKE
Practice Address - Street 2:STE 2
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5274
Practice Address - Country:US
Practice Address - Phone:860-647-8995
Practice Address - Fax:860-647-6930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001186101YA0400X
CT0061261041C0700X
CT006126,0073761041C0700X
CT000507,001079106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCBHP003857Medicaid
CT800003857Medicare PIN