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General NPI Number Information
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NPI Number | 1700132933
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Entity Type | Organization
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Legal Business Name | LIFECYCLE THERAPEUTIC SERVICES LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 349 FRANKLIN AVE SUITE 201
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City | NUTLEY
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State | NJ
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Zip | 07110-4004
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Country | US
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Telephone | 973-517-4062
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Fax |
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Provider Business Mailing Address
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Address Line | 349 FRANKLIN AVE SUITE 201
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City | NUTLEY
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State | NJ
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Zip | 07110-4004
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Country | US
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Telephone | 973-517-4062
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | AMANDA LEVY
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Credential | LCSW
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Telephone | 973-571-4062
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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 | 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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