Healthcare Provider Details

I. General information

NPI: 1356600316
Provider Name (Legal Business Name): PSYCH TOTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18947 JOHN J WILLIAMS HWY STE 210
REHOBOTH BEACH DE
19971-4474
US

IV. Provider business mailing address

18947 JOHN J WILLIAMS HWY STE 210
REHOBOTH BEACH DE
19971-4474
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-7981
  • Fax: 302-478-7393
Mailing address:
  • Phone: 302-478-7981
  • Fax: 302-478-7393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberC10005516
License Number StateDE

VIII. Authorized Official

Name: DR. DAVID KALKSTEIN
Title or Position: OWNER
Credential: MD
Phone: 302-478-7981