Healthcare Provider Details

I. General information

NPI: 1790774248
Provider Name (Legal Business Name): CONSULTING & THERAPEUTIC MODALITIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 CITY AVE STE 210
BALA CYNWYD PA
19004-1141
US

IV. Provider business mailing address

67 CYNTHIA DR
RICHBORO PA
18954-1331
US

V. Phone/Fax

Practice location:
  • Phone: 610-660-8338
  • Fax: 610-660-8339
Mailing address:
  • Phone: 215-364-1799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberB10000525
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS2609L
License Number StatePA

VIII. Authorized Official

Name: DR. ROMAN JOSEPH PASTUSHAK
Title or Position: PRES SOLE OWNER
Credential: PHD
Phone: 215-364-1799