Healthcare Provider Details

I. General information

NPI: 1720188014
Provider Name (Legal Business Name): LIFEPSYCH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 BROWNING LN BLDG C, SUITE 5
CHERRY HILL NJ
08003-3195
US

IV. Provider business mailing address

102 BROWNING LN STE 5
CHERRY HILL NJ
08003-3195
US

V. Phone/Fax

Practice location:
  • Phone: 856-857-0881
  • Fax: 610-361-9078
Mailing address:
  • Phone: 856-857-0881
  • Fax: 610-361-9078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberSI03313
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberSI03313
License Number StateNJ

VIII. Authorized Official

Name: DR. LELAND D MOSBY
Title or Position: PRESIDENT-CEO
Credential: PSYCHOLOGIST
Phone: 856-857-0881