Provider Demographics
NPI:1275619017
Name:FAMILY PSYCHIATRIC SERVICES PLLC
Entity Type:Organization
Organization Name:FAMILY PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:N
Authorized Official - Last Name:CASDORPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-343-5554
Mailing Address - Street 1:1573 WASHINGTON ST E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-2505
Mailing Address - Country:US
Mailing Address - Phone:304-343-5554
Mailing Address - Fax:304-343-8492
Practice Address - Street 1:1573 WASHINGTON ST E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-2505
Practice Address - Country:US
Practice Address - Phone:304-343-5554
Practice Address - Fax:304-343-8492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV754101Y00000X
WV766103T00000X
WV350104100000X
WV761104100000X
WV13222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005459Medicaid
WV3810005459Medicaid