Provider Demographics
NPI:1922395847
Name:CITY PARK PSYCHOLOGICAL SERVICES & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CITY PARK PSYCHOLOGICAL SERVICES & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOU
Authorized Official - Middle Name:A
Authorized Official - Last Name:LICHTI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-401-2813
Mailing Address - Street 1:209 W PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5515
Mailing Address - Country:US
Mailing Address - Phone:301-401-2813
Mailing Address - Fax:
Practice Address - Street 1:209 W PATRICK ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5515
Practice Address - Country:US
Practice Address - Phone:301-401-2813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2139103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty