Provider Demographics
NPI:1205352986
Name:A LIFE YOU LOVE, LLC
Entity type:Organization
Organization Name:A LIFE YOU LOVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEBLER-BROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:908-456-1871
Mailing Address - Street 1:221 NORTH AVE W
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2126
Mailing Address - Country:US
Mailing Address - Phone:908-456-1871
Mailing Address - Fax:
Practice Address - Street 1:34 DUMONT RD
Practice Address - Street 2:PO BOX 953
Practice Address - City:FAR HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07931-0793
Practice Address - Country:US
Practice Address - Phone:908-456-1871
Practice Address - Fax:908-456-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00083500251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management