Provider Demographics
NPI:1457520025
Name:LIFESPAN HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:LIFESPAN HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBOVITS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-995-9762
Mailing Address - Street 1:2295 NW CORPORATE BLVD
Mailing Address - Street 2:231
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7373
Mailing Address - Country:US
Mailing Address - Phone:561-995-9762
Mailing Address - Fax:561-995-9799
Practice Address - Street 1:2295 NW CORPORATE BLVD
Practice Address - Street 2:231
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7373
Practice Address - Country:US
Practice Address - Phone:561-995-9762
Practice Address - Fax:561-995-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5283103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty