Provider Demographics
NPI:1871846519
Name:PSYCHOTHERAPY SERVICES OF MORGANTOWN
Entity Type:Organization
Organization Name:PSYCHOTHERAPY SERVICES OF MORGANTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CZAJKA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:304-685-4631
Mailing Address - Street 1:1286 SUNCREST TOWN CENTRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1828
Mailing Address - Country:US
Mailing Address - Phone:304-685-4631
Mailing Address - Fax:304-381-2724
Practice Address - Street 1:1286 SUNCREST TOWN CENTRE DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1828
Practice Address - Country:US
Practice Address - Phone:304-685-4631
Practice Address - Fax:304-381-2724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009403321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCZSW33961OtherMEDICARE