Provider Demographics
NPI:1700146941
Name:LIFESPAN ASSOCIATES
Entity Type:Organization
Organization Name:LIFESPAN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-881-9000
Mailing Address - Street 1:120 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-1514
Mailing Address - Country:US
Mailing Address - Phone:215-881-9000
Mailing Address - Fax:215-881-7129
Practice Address - Street 1:120 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-1514
Practice Address - Country:US
Practice Address - Phone:215-881-9000
Practice Address - Fax:215-881-7129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005472L103T00000X
DEB1-0000390103T00000X
VA0810004259103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty