Provider Demographics
NPI:1881799872
Name:LIFE CHANGES UNLIMITED CORP.
Entity type:Organization
Organization Name:LIFE CHANGES UNLIMITED CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:RANDEE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:SHUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:845-708-0143
Mailing Address - Street 1:15 BELLOWS LN
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2442
Mailing Address - Country:US
Mailing Address - Phone:845-708-0143
Mailing Address - Fax:845-639-9515
Practice Address - Street 1:15 BELLOWS LN
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2442
Practice Address - Country:US
Practice Address - Phone:845-708-0143
Practice Address - Fax:845-639-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty