Provider Demographics
NPI:1023103124
Name:COMMUNITY PSYCHOLOGICAL RESOURCES
Entity type:Organization
Organization Name:COMMUNITY PSYCHOLOGICAL RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-622-6794
Mailing Address - Street 1:249 W YORK ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1520
Mailing Address - Country:US
Mailing Address - Phone:757-622-6794
Mailing Address - Fax:757-626-1509
Practice Address - Street 1:249 W YORK ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1520
Practice Address - Country:US
Practice Address - Phone:757-622-6794
Practice Address - Fax:757-626-1509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty