Provider Demographics
NPI:1881979169
Name:LIFEWORKS THERAPEUTICS LLC
Entity type:Organization
Organization Name:LIFEWORKS THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:WERBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-440-6013
Mailing Address - Street 1:126 CATHEDRAL ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2704
Mailing Address - Country:US
Mailing Address - Phone:443-440-6013
Mailing Address - Fax:443-440-6014
Practice Address - Street 1:126 CATHEDRAL ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2704
Practice Address - Country:US
Practice Address - Phone:443-440-6013
Practice Address - Fax:443-440-6014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
234394Medicare PIN