Healthcare Provider Details

I. General information

NPI: 1689699274
Provider Name (Legal Business Name): PSYCHOTHERAPEUTIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 PEACHTREE RUN RD
DOVER DE
19901
US

IV. Provider business mailing address

104 SPRING AVE UNIT 299
CHESTERTOWN MD
21620-8512
US

V. Phone/Fax

Practice location:
  • Phone: 302-480-9340
  • Fax: 302-480-9341
Mailing address:
  • Phone: 410-778-1099
  • Fax: 410-778-7988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ERIN OLIVER
Title or Position: TREASURER & CONTROLLER
Credential:
Phone: 410-778-1099