Provider Demographics
NPI:1992809289
Name:LIFE TRANSITIONS INC
Entity type:Organization
Organization Name:LIFE TRANSITIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMRS
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEMALO
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CAP
Authorized Official - Phone:941-627-2100
Mailing Address - Street 1:3505 DEPEW AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-7016
Mailing Address - Country:US
Mailing Address - Phone:941-627-2100
Mailing Address - Fax:941-627-6442
Practice Address - Street 1:3505 DEPEW CIRCLE
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-627-2100
Practice Address - Fax:941-627-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K2168Medicare UPIN
K2168Medicare ID - Type Unspecified