Provider Demographics
NPI:1801005442
Name:BEHAVIOR THERAPY CENTER OF GREATER WASHINGTON, P.A.
Entity Type:Organization
Organization Name:BEHAVIOR THERAPY CENTER OF GREATER WASHINGTON, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANSUETO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-593-4040
Mailing Address - Street 1:11227 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4562
Mailing Address - Country:US
Mailing Address - Phone:301-593-4040
Mailing Address - Fax:301-593-9148
Practice Address - Street 1:11227 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4562
Practice Address - Country:US
Practice Address - Phone:301-593-4040
Practice Address - Fax:301-593-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103TB0200X103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty