Provider Demographics
NPI:1457133662
Name:LIFE DESIGN BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:LIFE DESIGN BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER. CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PETRUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:856-304-0578
Mailing Address - Street 1:45 DELAWARE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-5931
Mailing Address - Country:US
Mailing Address - Phone:856-304-0578
Mailing Address - Fax:302-529-5806
Practice Address - Street 1:45 DELAWARE ST STE 2
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-5931
Practice Address - Country:US
Practice Address - Phone:856-304-0578
Practice Address - Fax:302-529-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty