Provider Demographics
NPI:1578971750
Name:MG THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:MG THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAMATGES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:484-445-4147
Mailing Address - Street 1:100 W 6TH ST, SUITE 305
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3228
Mailing Address - Country:US
Mailing Address - Phone:484-445-4147
Mailing Address - Fax:484-445-4149
Practice Address - Street 1:100 W 6TH ST, SUITE 305
Practice Address - Street 2:SUITE 305
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3228
Practice Address - Country:US
Practice Address - Phone:484-445-4147
Practice Address - Fax:484-445-4149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017448103G00000X, 103TA0400X, 103TC0700X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty