Provider Demographics
NPI:1326057704
Name:CENTER FOR PSYCHOTHERAPEUTIC SERVICES INC
Entity Type:Organization
Organization Name:CENTER FOR PSYCHOTHERAPEUTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHEPPARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-345-3898
Mailing Address - Street 1:1440 CORAL RIDGE DR
Mailing Address - Street 2:SUITE 288
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5433
Mailing Address - Country:US
Mailing Address - Phone:954-345-3898
Mailing Address - Fax:954-227-8037
Practice Address - Street 1:1440 CORAL RIDGE DR
Practice Address - Street 2:SUITE 288
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-5433
Practice Address - Country:US
Practice Address - Phone:954-345-3898
Practice Address - Fax:954-227-8037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW58491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty