Healthcare Provider Details

I. General information

NPI: 1992074751
Provider Name (Legal Business Name): LIFESKILLS & PSYCHOTHERAPY SERVICES,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 FOREST RD
CENTEREACH NY
11720-2244
US

IV. Provider business mailing address

18 FOREST RD
CENTEREACH NY
11720-2244
US

V. Phone/Fax

Practice location:
  • Phone: 631-648-7689
  • Fax: 631-648-7690
Mailing address:
  • Phone: 631-648-7689
  • Fax: 631-648-7690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR0270991
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANE O SEAMAN
Title or Position: OWNER
Credential: LCSW, BCD,
Phone: 631-648-7689