Healthcare Provider Details

I. General information

NPI: 1790496560
Provider Name (Legal Business Name): LIFETIME NEURODEVELOPMENTAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 REDWOOD HWY FRONTAGE RD BLDG SUITE225
MILL VALLEY CA
94941-3034
US

IV. Provider business mailing address

731 E WALNUT ST
PASADENA CA
91101-1613
US

V. Phone/Fax

Practice location:
  • Phone: 415-952-6050
  • Fax: 415-789-4516
Mailing address:
  • Phone: 415-952-6050
  • Fax: 415-789-4516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY STEELE
Title or Position: CFO AND PHYSICIAN
Credential: MD
Phone: 415-952-6050