Provider Demographics
NPI:1922596360
Name:PEAK LONGEVITY LLC
Entity Type:Organization
Organization Name:PEAK LONGEVITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, LCSW
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCUS, LCSW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-281-4325
Mailing Address - Street 1:451 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3070
Mailing Address - Country:US
Mailing Address - Phone:203-281-4325
Mailing Address - Fax:203-281-4324
Practice Address - Street 1:451 STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3070
Practice Address - Country:US
Practice Address - Phone:203-281-4325
Practice Address - Fax:203-281-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0059041041C0700X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140005904CT03OtherANTHEM BCBS