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General NPI Number Information
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NPI Number | 1457133662
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Entity Type | Organization
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Legal Business Name | LIFE DESIGN BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 45 DELAWARE ST STE 2
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City | WOODBURY
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State | NJ
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Zip | 08096-5931
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Country | US
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Telephone | 856-304-0578
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Fax | 302-529-5806
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Provider Business Mailing Address
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Address Line | 45 DELAWARE ST STE 2
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City | WOODBURY
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State | NJ
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Zip | 08096-5931
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Country | US
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Telephone | 856-304-0578
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Fax | 302-529-5806
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Authorized Official
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Title or Position | OWNER. CLINICAL SOCIAL WORKER
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Name | SUZANNE MARIE PETRUCCI
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Credential | LCSW
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Telephone | 856-304-0578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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