Provider Demographics
NPI:1396870820
Name:LIFESKILLSANDPSYCHOTHERAPY SERVICES, PC
Entity type:Organization
Organization Name:LIFESKILLSANDPSYCHOTHERAPY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:O
Authorized Official - Last Name:SEAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,ACSW,BCDCERTMIN
Authorized Official - Phone:631-467-2554
Mailing Address - Street 1:1050 HALLOCK AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:631-467-6649
Practice Address - Street 1:1050 HALLOCK AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1214
Practice Address - Country:US
Practice Address - Phone:631-467-2554
Practice Address - Fax:631-467-6649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty