MEDICARE: LIFELINE TO RECOVERY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	PY7715	FL

General Provider Information

NPI Number	:	1477976918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINE TO RECOVERY INC

Provider Business Mailing Address
First Line	:	2290 10TH AVE N STE 201
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-6609
Country	:	US
Telephone Number	:	561-223-3140
Fax Number	:

Provider Business Practice Location Address
First Line	:	2290 10TH AVE N STE 201
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-6609
Country	:	US
Telephone Number	:	561-223-3140
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LISA CICETTI
Credential	:	PSY.D., LMHC
Telephone Number	:	561-734-6118

Provider Enumeration Date	:	02/03/2014
Last Update Date	:	02/03/2014

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Directions to “LIFELINE TO RECOVERY INC ” Practice Location

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