Provider Demographics
NPI:1093053761
Name:NEW LIFE PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:NEW LIFE PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:717-606-7652
Mailing Address - Street 1:1025 S COCALICO RD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:PA
Mailing Address - Zip Code:17517-9545
Mailing Address - Country:US
Mailing Address - Phone:717-606-7652
Mailing Address - Fax:717-336-4014
Practice Address - Street 1:1025 S COCALICO RD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:PA
Practice Address - Zip Code:17517-9545
Practice Address - Country:US
Practice Address - Phone:717-606-7652
Practice Address - Fax:717-336-4014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006830L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR57923Medicare UPIN