Organization
PSYCHOTHERAPEUTIC REHABILATION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL COOPER CPA (CFO)
(410) 778-9114
Entity
Organization
Contact information
Practice address
337 BRIGHTSEAT RD, SUITE 106 & 107, LANDOVER, MD 20785-4736
(301) 499-6870
(301) 499-1448
Mailing address
820 HIGH STREET, SUITE 2, CHESTERTOWN, MD 21620-3909
(410) 778-9114
(410) 778-7988
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
589411500
—
MD
Enumeration date
02/15/2007
Last updated
06/19/2008
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