Healthcare Provider Details

I. General information

NPI: 1023395910
Provider Name (Legal Business Name): THE LIFE SKILLS SCHOOL, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 QUEENS BLVD
REGO PARK NY
11374-3245
US

IV. Provider business mailing address

9730 QUEENS BLVD
REGO PARK NY
11374-3245
US

V. Phone/Fax

Practice location:
  • Phone: 718-897-5822
  • Fax: 718-459-0382
Mailing address:
  • Phone: 718-897-5822
  • Fax: 718-459-0382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAMIKA DANIELS
Title or Position: SOCIAL WORKER
Credential: MA, LCSW, LMHC
Phone: 718-897-5822