Healthcare Provider Details

I. General information

NPI: 1346892437
Provider Name (Legal Business Name): L&L LIFE ENRICHMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LIBERTY ST
SPRINGFIELD MA
01103-1114
US

IV. Provider business mailing address

125 LIBERTY ST
SPRINGFIELD MA
01103-1114
US

V. Phone/Fax

Practice location:
  • Phone: 347-458-0085
  • Fax:
Mailing address:
  • Phone: 347-458-0085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LOLITA HANLEY
Title or Position: OWNER
Credential: PSYD, LADC
Phone: 347-458-0085