Provider Demographics
NPI:1013375757
Name:ADAPTIVE THERAPY, INC.
Entity Type:Organization
Organization Name:ADAPTIVE THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:OLIMPIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:ETTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-576-7237
Mailing Address - Street 1:6015 NEW FOREST CT
Mailing Address - Street 2:APT 5
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4735
Mailing Address - Country:US
Mailing Address - Phone:240-607-9207
Mailing Address - Fax:301-934-2640
Practice Address - Street 1:109 LA GRANGE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-9592
Practice Address - Country:US
Practice Address - Phone:240-253-7051
Practice Address - Fax:301-934-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD152171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty