Provider Demographics
NPI:1790496560
Name:LIFETIME NEURODEVELOPMENTAL CARE INC
Entity Type:Organization
Organization Name:LIFETIME NEURODEVELOPMENTAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO AND PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-952-6095
Mailing Address - Street 1:4212 GRIMES PL
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4358
Mailing Address - Country:US
Mailing Address - Phone:415-952-6095
Mailing Address - Fax:
Practice Address - Street 1:4212 GRIMES PL
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4358
Practice Address - Country:US
Practice Address - Phone:415-952-6095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty