| Community Therapeutic Center,inc | |
|
4325 Forbes Blvd Ste A Lanham MD 20706-4853 | |
| (240) 764-5133 | |
| Not Available |
| Full Name | Community Therapeutic Center,inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4325 Forbes Blvd Ste A, Lanham, Maryland |
| Authorized Official Name and Position | Emmanuel O Owooje (PRESIDENT) |
| Authorized Official Contact | 2407645133 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Therapeutic Center,inc 4325 Forbes Blvd Ste A Lanham MD 20706-4853 Ph: (240) 764-5133 | Community Therapeutic Center,inc 4325 Forbes Blvd Ste A Lanham MD 20706-4853 Ph: (240) 764-5133 |
| NPI Number | 1417416694 |
|---|---|
| Provider Enumeration Date | 03/18/2019 |
| Last Update Date | 05/19/2021 |
| Certification Date | 05/19/2021 |
| Medicare PECOS PAC ID | 8123492303 |
|---|---|
| Medicare Enrollment ID | O20230330001202 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417416694 | NPI | - | NPPES |
| 1900222600 | Medicaid | MD |
| Provider Name | Dawit T Yaszi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639686942 PECOS PAC ID: 1052672359 Enrollment ID: I20180301001609 |
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