Provider Demographics
NPI:1447405121
Name:LIFESTART
Entity Type:Organization
Organization Name:LIFESTART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:LIANNI
Authorized Official - Last Name:LANNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-291-8383
Mailing Address - Street 1:320 E 23RD ST
Mailing Address - Street 2:APT 14 L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4713
Mailing Address - Country:US
Mailing Address - Phone:212-991-5510
Mailing Address - Fax:
Practice Address - Street 1:320 E 23RD ST
Practice Address - Street 2:APT 14 L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4713
Practice Address - Country:US
Practice Address - Phone:212-991-5510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-23
Last Update Date:2008-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017284-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency