Healthcare Provider Details

I. General information

NPI: 1053843029
Provider Name (Legal Business Name): THERAPEUTIC SUPERVENTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 NATIONAL DR STE 230
BURTONSVILLE MD
20866-6101
US

IV. Provider business mailing address

14373 HOWARD RD
DAYTON MD
21036-1014
US

V. Phone/Fax

Practice location:
  • Phone: 240-650-0779
  • Fax: 443-583-3872
Mailing address:
  • Phone: 301-256-5243
  • Fax: 443-583-3872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number03945
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number03945
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number03945
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number03945
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number03945
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. GEETA SARPHARE
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 301-256-5243