Provider Demographics
NPI:1356679203
Name:LIFE SKILLS CASE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:LIFE SKILLS CASE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ADDICTION COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HIRSEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:CAC
Authorized Official - Phone:561-789-5577
Mailing Address - Street 1:1030 S FEDERAL HWY STE 111
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5193
Mailing Address - Country:US
Mailing Address - Phone:561-789-5577
Mailing Address - Fax:208-975-1069
Practice Address - Street 1:1030 S FEDERAL HWY STE 111
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5193
Practice Address - Country:US
Practice Address - Phone:561-789-5577
Practice Address - Fax:208-975-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1550ADO82601251B00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management