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General NPI Number Information
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NPI Number | 1760056048
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Entity Type | Organization
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Legal Business Name | LIFE BY DESIGN THERAPEUTIC & COACHING SERVICES PLLC
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 280 DOBBS FERRY RD STE 102
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City | WHITE PLAINS
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State | NY
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Zip | 10607-1908
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Country | US
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Telephone | 646-760-7921
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Fax | 347-851-1580
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Provider Business Mailing Address
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Address Line | 429 E PROSPECT AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10553-1124
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Country | US
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Telephone | 646-760-7921
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Fax | 347-851-1580
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | MRS. KIMBERLY LAUREN BONDS GROCHER
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Credential | LCSW
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Telephone | 646-760-7921
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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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