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General NPI Number Information
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NPI Number | 1164598199
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Entity Type | Organization
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Legal Business Name | LIFE MANAGEMENT ASSOCIATES INC
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 10/28/2011
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Provider Practice Location Address
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Address Line | 257 AYER RD
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City | HARVARD
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State | MA
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Zip | 01451-1108
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Country | US
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Telephone | 978-772-4457
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Fax | 978-772-7107
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Provider Business Mailing Address
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Address Line | PO BOX 904
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City | ACTON
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State | MA
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Zip | 01720-0904
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Country | US
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Telephone | 978-772-4457
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Fax | 978-772-7107
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN R MICHELSON
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Credential | PHD
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Telephone | 978-772-4457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1543
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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