Provider Demographics
NPI:1881233872
Name:LIFESPAN BEHAVIORAL HEALTH SERVICES PC
Entity type:Organization
Organization Name:LIFESPAN BEHAVIORAL HEALTH SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:REIDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-590-3230
Mailing Address - Street 1:2705 SILVER HAMMER WAY
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-3244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7474 GREENWAY CENTER DR STE 700A
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3523
Practice Address - Country:US
Practice Address - Phone:301-982-3437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty