Provider Demographics
NPI:1750526554
Name:CENTER FOR PEDIATRIC THERAPY
Entity type:Organization
Organization Name:CENTER FOR PEDIATRIC THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SANDS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NBCC, LPC
Authorized Official - Phone:610-670-8600
Mailing Address - Street 1:9 BRISTOL CT
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1851
Mailing Address - Country:US
Mailing Address - Phone:610-670-8600
Mailing Address - Fax:
Practice Address - Street 1:9 BRISTOL COURT
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1851
Practice Address - Country:US
Practice Address - Phone:610-670-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005024251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management