Healthcare Provider Details

I. General information

NPI: 1164598199
Provider Name (Legal Business Name): LIFE MANAGEMENT ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 AYER RD
HARVARD MA
01451-1108
US

IV. Provider business mailing address

PO BOX 904
ACTON MA
01720-0904
US

V. Phone/Fax

Practice location:
  • Phone: 978-772-4457
  • Fax: 978-772-7107
Mailing address:
  • Phone: 978-772-4457
  • Fax: 978-772-7107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1543
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN R MICHELSON
Title or Position: PRESIDENT
Credential: PHD
Phone: 978-772-4457