Healthcare Provider Details

I. General information

NPI: 1063998102
Provider Name (Legal Business Name): THERAPY STORES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BROADWAY STE 1800
NEW YORK NY
10006-1652
US

IV. Provider business mailing address

1350 CONNECTICUT AVE NW STE 800
WASHINGTON DC
20036-1733
US

V. Phone/Fax

Practice location:
  • Phone: 212-234-6167
  • Fax:
Mailing address:
  • Phone: 202-986-5941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY RAY BRENNER
Title or Position: PARTNER AND CEO
Credential: PH.D.
Phone: 202-986-5941