LIFESPAN COUNSELING CENTER LLC (NPI# 1104287564) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104287564 |
| Entity Type | Organization |
| Organization Name | LIFESPAN COUNSELING CENTER LLC |
| Practice Address |
729 Grove Ave Suite 3 Southampton PA 18966-6008 |
| Practice Telephone | 2153558812 |
| Practice Fax Number | 2153550926 |
| Mailing Telephone | 2153558812 |
| Mailing Fax Number | 2153550926 |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2016-03-14 |
| Authorized Official Name | DR. ANDREA SYWULAK MANNINO (OWNER) |
| Authorized Official Telephone | 2153558812 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
PA-003501-L | PA | Behavioral Health & Social Service Providers |
| Street Address |
729 GROVE AVE SUITE 3 |
| City | SOUTHAMPTON |
| State | PA |
| Zip Code | 18966-6008 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588639165 | Richard L. Tepper | Internal Medicine | 729 Grove Ave, Unit 4, Southampton, PA 18966-6008 | 2006-02-17 |
| 1366633687 | Christopher J Schaufler | Chiropractor | 729 Grove Ave, Suite 2, Southampton, PA 18966-6008 | 2007-08-05 |
| 1407810328 | Christopher John Schaufler | Chiropractor | 729 Grove Ave, Suite 2, Southampton, PA 18966-6008 | 2006-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033758636 | Nancy Rubin | Speech-Language Pathologist | Nancy Rubin, 32 Brook Drive, Southampton, PA 18966 | 2019-12-30 |
| 1265970669 | Dominic Bogucki | Specialist/Technologist | 75 Meadowfield Dr, Southampton, PA 18966 | 2017-02-06 |
| 1518404359 | Amanda Phillips | Social Worker | 504 Lakeside Office Park, Suite 504, Southampton, PA 18966 | 2017-01-31 |
| 1386988830 | Sara Beth Bergman | Occupational Therapy Assistant | 1354 Hi View Drive, Southampton, PA 18966 | 2012-11-22 |
| 1326325523 | Annie Varughese | Pharmacist | 139 Lark Dr, Holland, PA 18966 | 2011-11-16 |
| 1912284993 | Christine Renee Nichols | Social Worker | 1030 Second Street Pike, Southampton, PA 18966 | 2011-11-04 |
| 1407134125 | Apex Smiles LLC | Dentist | 771 2nd Street Pike, Southampton, PA 18966 | 2011-07-29 |
| 1790092708 | The Comprehensive Learning Center, Inc. | Community/Behavioral Health | 150 James Way, Southampton, PA 18966 | 2010-09-13 |
| 1861713786 | Austin Patrick Daly | Dentist | 404 Lakeside Park, Southampton, PA 18966 | 2010-06-15 |
| 1164660015 | Andrew J Sohl | Podiatrist | 86 Buck Rd Ste 2, Southampton, PA 18966 | 2009-01-30 |
| Find all providers in zip 18966 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336621762 | Tina Marie Gonzales | Psychologist | 928 Jaymor Road Suite B-150, Southampton, PA 19040 | 2018-09-01 |
| 1174780258 | Joseph G. Rosenfeld | Psychologist | 43 Springwood Dr, Southampton, PA 18966-3054 | 2008-05-17 |
| 1740318039 | Elene Jessica Costuck | Psychologist | 168 Hill St, Southampton, NY 11968-5310 | 2007-03-01 |
| 1841339397 | Kathleen M. Dillon | Psychologist | 139 Fomer Rd, Southampton, MA 01073-9516 | 2007-02-05 |
| 1013926583 | Southampton Psychiatric Associates PC | Psychologist | 1111 Street Rd, Suite 312, Southampton, PA 18966-4250 | 2006-08-05 |
| 1811924038 | Fred Larry Dorfman | Psychologist | 707 Lakeside Park, Southampton, PA 18966-4020 | 2006-06-26 |
| 1275531634 | Steven R. Cohen | Psychologist | 967 Street Rd, Southampton, PA 18966-4728 | 2005-07-11 |
| 1285157172 | Jennifer Rebekah Nowak | Psychologist | 928 Jaymor Rd Ste B-150, Southampton, PA 18966-3853 | 2017-07-21 |
| 1417314758 | Deborah Meyrowitz Weiss LLC | Psychologist | 1111 Street Rd, Suite 101, Southampton, PA 18966-4250 | 2016-01-18 |
| 1063814283 | Megan Dufford | Psychologist | 928 Jaymor Rd Ste C-120, Southampton, PA 18966-3835 | 2014-09-18 |
| Find all providers in SOUTHAMPTON | ||||
| City | SOUTHAMPTON |
| Zip Code | 18966 |
Please comment or provide details below to improve the information on LIFESPAN COUNSELING CENTER LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.