Provider Demographics
NPI:1790774248
Name:CONSULTING & THERAPEUTIC MODALITIES INC
Entity Type:Organization
Organization Name:CONSULTING & THERAPEUTIC MODALITIES INC
Other - Org Name:ROMAN J PASTUSHAK
Other - Org Type:Other Name
Authorized Official - Title/Position:PRES SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PASTUSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-364-1799
Mailing Address - Street 1:67 CYNTHIA DR
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1331
Mailing Address - Country:US
Mailing Address - Phone:215-364-1799
Mailing Address - Fax:
Practice Address - Street 1:555 CITY AVE
Practice Address - Street 2:STE 210
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1141
Practice Address - Country:US
Practice Address - Phone:610-660-8338
Practice Address - Fax:610-660-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS2609L103TC1900X
DEB10000525103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7402114OtherAETNA
PA107404Medicare ID - Type Unspecified
R06101Medicare UPIN