Healthcare Provider Details

I. General information

NPI: 1609713312
Provider Name (Legal Business Name): LIFE LEARNING ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 8TH ST
SAN FRANCISCO CA
94130-1901
US

IV. Provider business mailing address

651 8TH ST
SAN FRANCISCO CA
94130-1901
US

V. Phone/Fax

Practice location:
  • Phone: 650-416-6881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MIA SEMELMAN
Title or Position: TRAINING DIRECTOR AND SUPERVISOR
Credential: PSYD
Phone: 650-416-6881