Provider Demographics
NPI:1720188014
Name:LIFEPSYCH CORP
Entity Type:Organization
Organization Name:LIFEPSYCH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOSBY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCHOLOGIST
Authorized Official - Phone:856-857-0881
Mailing Address - Street 1:102 BROWNING LN STE 5
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3195
Mailing Address - Country:US
Mailing Address - Phone:856-857-0881
Mailing Address - Fax:610-361-9078
Practice Address - Street 1:102 BROWNING LN
Practice Address - Street 2:BLDG C, SUITE 5
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3195
Practice Address - Country:US
Practice Address - Phone:856-857-0881
Practice Address - Fax:610-361-9078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI03313103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3546773OtherAETNA
NJ001664744OtherPERSONAL CHOICE
PA2319112000OtherPA BC
NJ84554302Medicaid
NJ2319112000OtherAMERIA HEALTH
NJ538606000OtherMAGELLAN