Provider Demographics
NPI:1033379599
Name:LIFEWORKS BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:LIFEWORKS BEHAVIORAL HEALTH
Other - Org Name:SAINT CLARE'S PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CEAP, SAP, CART
Authorized Official - Phone:973-537-3040
Mailing Address - Street 1:400 W BLACKWELL ST
Mailing Address - Street 2:SAINT CLARE'S HEALTH SYSTEM, SR. CATHERINE'S HEALTH CTR
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-2525
Mailing Address - Country:US
Mailing Address - Phone:973-537-3940
Mailing Address - Fax:973-537-3941
Practice Address - Street 1:400 W BLACKWELL ST
Practice Address - Street 2:SAINT CLARE'S HEALTH SYSTEM, SR. CATHERINE'S HEALTH CTR
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-2525
Practice Address - Country:US
Practice Address - Phone:973-537-3940
Practice Address - Fax:973-537-3941
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT CLARE'S PRIMARY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC010114001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty