| Life Span Development Center | |
|
260 Chapman Rd Suite 200-1 Newark DE 19702-5490 | |
| (302) 399-5773 | |
| (302) 832-9795 |
| Full Name | Life Span Development Center |
|---|---|
| Speciality | Social Worker |
| Location | 260 Chapman Rd, Newark, Delaware |
| Authorized Official Name and Position | Lamonte G Wilson (OWNER/CLINICIAN) |
| Authorized Official Contact | 3023995773 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Span Development Center 260 Chapman Rd Suite 200-1 Newark DE 19702-5490 Ph: (302) 399-5773 | Life Span Development Center 260 Chapman Rd Suite 200-1 Newark DE 19702-5490 Ph: (302) 399-5773 |
| NPI Number | 1902356025 |
|---|---|
| Provider Enumeration Date | 10/12/2016 |
| Last Update Date | 06/22/2017 |
| Medicare PECOS PAC ID | 8921377458 |
|---|---|
| Medicare Enrollment ID | O20170627000767 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902356025 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | Q1-0000548 (Delaware) | Primary |
| Provider Name | Lamonte G Wilson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649257346 PECOS PAC ID: 1355610882 Enrollment ID: I20170503000297 |
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