NPIMap

Organization Active NPI

Psychotherapeutic Services of Southern Maryland

  • Group Psychotherapy Psychologist
  • Waldorf, MD
National Provider Identifier
1003988627
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Group Psychotherapy PsychologistTaxonomy code 103TP2701X
Legal business name
PSYCHOTHERAPEUTIC SERVICES OF SOUTHERN MARYLAND
Practice address
105 Paul Mellon CT
Suite 19, 20
Waldorf, MD 20602-2762
Phone
(301) 638-7787
Fax
(301) 638-7768
NPI assigned
Nov 15, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Randall Cooper, CPA
Title
Chief Financial Officer
Phone
(410) 778-9114

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Group Psychotherapy Psychologist 103TP2701X Primary

Addresses

Primary practice location

105 Paul Mellon CT
Suite 19, 20
Waldorf, MD 20602-2762

Mailing address

PO Box 690
Chestertown, MD 21620-0690
Phone (410) 778-9114

National Provider Directory

National Provider Directory
Tax ID family
Psychotherapeutic Services of Southern Maryland5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

105 Paul Mellon Ct
Ste 19
Waldorf, MD 20602
Phone (301) 638-7787

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003988627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 690",
            "city": "CHESTERTOWN",
            "state": "MD",
            "postal_code": "216200690",
            "telephone_number": "410-778-9114",
            "fax_number": "410-778-7988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 PAUL MELLON CT",
            "address_2": "SUITE 19, 20",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206022762",
            "telephone_number": "301-638-7787",
            "fax_number": "301-638-7768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOTHERAPEUTIC SERVICES OF SOUTHERN MARYLAND",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "410-778-9114",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.