Provider Demographics
NPI:1437928389
Name:S M PAUL LIFESTYLE DESIGN, LLC
Entity Type:Organization
Organization Name:S M PAUL LIFESTYLE DESIGN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-858-9046
Mailing Address - Street 1:1234 HYDE PARK AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2819
Mailing Address - Country:US
Mailing Address - Phone:617-858-9046
Mailing Address - Fax:
Practice Address - Street 1:10 TABER ST UNIT 307
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-4147
Practice Address - Country:US
Practice Address - Phone:617-858-9046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)