Healthcare Provider Details

I. General information

NPI: 1801125760
Provider Name (Legal Business Name): LIFE MANAGEMENT FOR ADULTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 07/21/2022
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 LADD ST FL 4
PORTSMOUTH NH
03801-4087
US

IV. Provider business mailing address

PO BOX 969
PORTSMOUTH NH
03802-0969
US

V. Phone/Fax

Practice location:
  • Phone: 603-205-2953
  • Fax: 888-499-1213
Mailing address:
  • Phone: 603-205-2953
  • Fax: 888-499-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14388
License Number StateNH

VIII. Authorized Official

Name: TRICIA POBLETE MENDOZA
Title or Position: OWNER
Credential: MD
Phone: 603-205-2953