MEDICARE: LIFE BY DESIGN, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	429704	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053345918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE BY DESIGN, PA

Provider Business Mailing Address
First Line	:	147 ACADEMY ST
Second Line	:
City	:	PRESQUE ISLE
State	:	ME
Zip	:	04769-3101
Country	:	US
Telephone Number	:	207-764-6825
Fax Number	:	207-764-6077

Provider Business Practice Location Address
First Line	:	147 ACADEMY ST
Second Line	:
City	:	PRESQUE ISLE
State	:	ME
Zip	:	04769-3101
Country	:	US
Telephone Number	:	207-764-6825
Fax Number	:	207-764-6077

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. DEBORAH A GRAY
Credential	:	LCSW, MHRT-C, CTCM
Telephone Number	:	207-764-6825

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	06/20/2023

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Directions to “LIFE BY DESIGN, PA ” Practice Location

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