Provider Demographics
NPI:1265993778
Name:YOUR VISION FOR LIFE PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:YOUR VISION FOR LIFE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSY P
Authorized Official - Phone:216-631-3230
Mailing Address - Street 1:8699 W CHESTER PIKE FL 2
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1101
Mailing Address - Country:US
Mailing Address - Phone:215-631-3230
Mailing Address - Fax:
Practice Address - Street 1:8699 W CHESTER PIKE FL 2
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1101
Practice Address - Country:US
Practice Address - Phone:215-631-3230
Practice Address - Fax:610-628-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)