Provider Demographics
NPI:1497709588
Name:LIFE CHANGING PSYCHOLOGICAL SERVICES,PLLC
Entity Type:Organization
Organization Name:LIFE CHANGING PSYCHOLOGICAL SERVICES,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PENNI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WALDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:914-961-8412
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-0215
Mailing Address - Country:US
Mailing Address - Phone:914-961-8412
Mailing Address - Fax:914-961-8412
Practice Address - Street 1:153 MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2317
Practice Address - Country:US
Practice Address - Phone:914-961-8412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-21
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0154791103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWGW281OtherMEDICARE