Provider Demographics
NPI:1922628155
Name:THERACARE MANAGED SERVICES, LLC
Entity Type:Organization
Organization Name:THERACARE MANAGED SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACT DEVELOPMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-564-2350
Mailing Address - Street 1:1133 WESTCHESTER AVE.
Mailing Address - Street 2:N230
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3516
Mailing Address - Country:US
Mailing Address - Phone:212-564-2350
Mailing Address - Fax:212-564-2578
Practice Address - Street 1:67 WALNUT AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1640
Practice Address - Country:US
Practice Address - Phone:855-681-8555
Practice Address - Fax:914-560-2102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERACARE OF NEW YORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty