Basic Information
Provider Information
NPI: 1881233872
EntityType: 2
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OrganizationName: LIFESPAN BEHAVIORAL HEALTH SERVICES PC
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Mailing Information
Address1: 2705 SILVER HAMMER WAY
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City: BROOKEVILLE
State: MD
PostalCode: 208333244
CountryCode: US
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Practice Location
Address1: 7474 GREENWAY CENTER DR STE 700A
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City: GREENBELT
State: MD
PostalCode: 207703523
CountryCode: US
TelephoneNumber: 3019823437
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Other Information
ProviderEnumerationDate: 12/23/2019
LastUpdateDate: 12/23/2019
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AuthorizedOfficialLastName: REIDY
AuthorizedOfficialFirstName: CAROLYN
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AuthorizedOfficialTitleorPosition: OFFICE ADMINISTRATOR
AuthorizedOfficialTelephone: 8455903230
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IsOrganizationSubpart: N
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NPICertificationDate: 12/23/2019

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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