Healthcare Provider Details

I. General information

NPI: 1902068950
Provider Name (Legal Business Name): LIFE STRATEGIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 SUMMIT AVE 2ND FLR
HACKENSACK NJ
07601-1262
US

IV. Provider business mailing address

83 SUMMIT AVE 2ND FLR
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 201-224-5200
  • Fax: 201-224-0599
Mailing address:
  • Phone: 201-224-5200
  • Fax: 201-224-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number26NJ00080100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: VANESSA GOURDINE
Title or Position: CLINICAL DIRECTOR
Credential: APN C
Phone: 201-224-5200