Healthcare Provider Details

I. General information

NPI: 1619143021
Provider Name (Legal Business Name): LIFESPAN SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7702 MASSACHUSETTS AVE
NEW PORT RICHEY FL
34653-3024
US

IV. Provider business mailing address

7702 MASSACHUSETTS AVE
NEW PORT RICHEY FL
34653-3024
US

V. Phone/Fax

Practice location:
  • Phone: 727-847-0069
  • Fax: 727-849-3780
Mailing address:
  • Phone: 727-847-0069
  • Fax: 727-849-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SABRINA CANON
Title or Position: OFFICE COORDINATOR
Credential:
Phone: 727-847-0069