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General NPI Number Information
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NPI Number | 1093053761
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Entity Type | Organization
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Legal Business Name | NEW LIFE PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 01/30/2013
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 1025 S COCALICO RD
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City | DENVER
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State | PA
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Zip | 17517-9545
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Country | US
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Telephone | 717-606-7652
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Fax | 717-336-4014
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Provider Business Mailing Address
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Address Line | 1025 S COCALICO RD
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City | DENVER
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State | PA
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Zip | 17517-9545
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Country | US
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Telephone | 717-606-7652
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Fax | 717-336-4014
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JOHN E PUGH
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Credential | PH.D.
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Telephone | 717-606-7652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS006830L
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License Number State | PA
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