Basic Information
| Provider Information | |||||||||
| NPI: | 1801125760 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFE MANAGEMENT FOR ADULTS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 969 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038020969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032052953 | ||||||||
| FaxNumber: | 8884991213 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 LADD ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038014087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032052953 | ||||||||
| FaxNumber: | 8884991213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2009 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | MENDOZA | ||||||||
| AuthorizedOfficialFirstName: | TRICIA | ||||||||
| AuthorizedOfficialMiddleName: | POBLETE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6032052953 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 14388 | NH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.