Provider Demographics
NPI:1689699274
Name:PSYCHOTHERAPEUTIC SERVICES INC
Entity Type:Organization
Organization Name:PSYCHOTHERAPEUTIC SERVICES INC
Other - Org Name:CORA'S PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-810-2468
Mailing Address - Street 1:870 HIGH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-3914
Mailing Address - Country:US
Mailing Address - Phone:410-778-1099
Mailing Address - Fax:410-778-7988
Practice Address - Street 1:2015 PEACHTREE RUN RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901
Practice Address - Country:US
Practice Address - Phone:302-480-9340
Practice Address - Fax:302-480-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000520561Medicaid