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General NPI Number Information
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NPI Number | 1992809289
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Entity Type | Organization
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Legal Business Name | LIFE TRANSITIONS INC
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Dates
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Enumeration Date | 09/08/2006
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Last Update Date | 10/26/2012
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Provider Practice Location Address
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Address Line | 3505 DEPEW CIRCLE
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952
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Country | US
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Telephone | 941-627-2100
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Fax | 941-627-6442
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Provider Business Mailing Address
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Address Line | 3505 DEPEW AVE
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-7016
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Country | US
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Telephone | 941-627-2100
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Fax | 941-627-6442
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | MR. JAMRS S DEMALO
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Credential | MS,CAP
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Telephone | 941-627-2100
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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 | FL
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