Provider Demographics
NPI:1588656672
Name:PSYCHOTHERAPY ASSOCIATES OF WINCHESTER
Entity Type:Organization
Organization Name:PSYCHOTHERAPY ASSOCIATES OF WINCHESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:CRANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:540-667-8665
Mailing Address - Street 1:125 S CAMERON ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4732
Mailing Address - Country:US
Mailing Address - Phone:540-722-0750
Mailing Address - Fax:540-722-0751
Practice Address - Street 1:125 S CAMERON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4732
Practice Address - Country:US
Practice Address - Phone:540-722-0750
Practice Address - Fax:540-722-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001152103TC0700X
VA09040034811041C0700X
VA09040009581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty