Provider Demographics
NPI:1033329487
Name:LIFEWORKS OF SONOMA COUNTY
Entity Type:Organization
Organization Name:LIFEWORKS OF SONOMA COUNTY
Other - Org Name:LIFEWORKS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-568-2300
Mailing Address - Street 1:1200 COLLEGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3908
Mailing Address - Country:US
Mailing Address - Phone:707-568-2300
Mailing Address - Fax:707-568-2304
Practice Address - Street 1:5450 SNYDER LANE
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2906
Practice Address - Country:US
Practice Address - Phone:707-792-6506
Practice Address - Fax:707-792-4758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 13055251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health