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General NPI Number Information
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NPI Number | 1801415443
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Entity Type | Organization
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Legal Business Name | LIFESPAN BEHAVIORAL HEALTH SERVICES PC
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 3416 OLANDWOOD CT STE 201
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City | OLNEY
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State | MD
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Zip | 20832-1373
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Country | US
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Telephone | 301-969-4060
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Fax |
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Provider Business Mailing Address
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Address Line | 2705 SILVER HAMMER WAY
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City | BROOKEVILLE
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State | MD
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Zip | 20833-3244
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE ADMIN
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Name | CAROLYN REIDY
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Credential |
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Telephone | 800-819-7570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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