Provider Demographics
NPI:1740531789
Name:LIFESPAN HEALTH NETWORK, A PSYCHOLOGY CORPORATION
Entity type:Organization
Organization Name:LIFESPAN HEALTH NETWORK, A PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-734-5579
Mailing Address - Street 1:4929 WILSHIRE BLVD
Mailing Address - Street 2:STE 510
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3808
Mailing Address - Country:US
Mailing Address - Phone:310-734-5579
Mailing Address - Fax:310-734-5511
Practice Address - Street 1:4929 WILSHIRE BLVD
Practice Address - Street 2:STE 510
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3808
Practice Address - Country:US
Practice Address - Phone:310-734-5579
Practice Address - Fax:310-734-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty