Provider Demographics
NPI:1841521747
Name:CENTER FOR COLLABORATIVE PSYCHOTHERAPY PA
Entity type:Organization
Organization Name:CENTER FOR COLLABORATIVE PSYCHOTHERAPY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:207-771-2001
Mailing Address - Street 1:80 SIMPSON RD
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-9523
Mailing Address - Country:US
Mailing Address - Phone:207-771-2001
Mailing Address - Fax:207-771-2001
Practice Address - Street 1:80 SIMPSON RD
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-9523
Practice Address - Country:US
Practice Address - Phone:207-771-2001
Practice Address - Fax:207-771-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1087103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty