| Lifepsych Corp | |
|
102 Browning Ln Bldg C, Suite 5 Cherry Hill NJ 08003-3195 | |
| (856) 857-0881 | |
| (610) 361-9078 |
| Full Name | Lifepsych Corp |
|---|---|
| Speciality | Psychologist |
| Location | 102 Browning Ln, Cherry Hill, New Jersey |
| Authorized Official Name and Position | Leland D Mosby (PRESIDENT-CEO) |
| Authorized Official Contact | 8568570881 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifepsych Corp 102 Browning Ln Ste 5 Cherry Hill NJ 08003-3195 Ph: (856) 857-0881 | Lifepsych Corp 102 Browning Ln Bldg C, Suite 5 Cherry Hill NJ 08003-3195 Ph: (856) 857-0881 |
| NPI Number | 1720188014 |
|---|---|
| Provider Enumeration Date | 09/25/2006 |
| Last Update Date | 07/14/2023 |
| Certification Date | 07/14/2023 |
| Medicare PECOS PAC ID | 5395717375 |
|---|---|
| Medicare Enrollment ID | O20040810000942 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720188014 | NPI | - | NPPES |
| 3546773 | Other | NJ | AETNA |
| 001664744 | Other | NJ | PERSONAL CHOICE |
| 2319112000 | Other | PA | PA BC |
| 84554302 | Medicaid | NJ | |
| 2319112000 | Other | NJ | AMERIA HEALTH |
| 538606000 | Other | NJ | MAGELLAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | SI03313 (New Jersey) | Primary |
| 103TF0200X | Psychologist - Forensic | SI03313 (New Jersey) | Secondary |
| Provider Name | Leland D Mosby |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366505828 PECOS PAC ID: 9638141617 Enrollment ID: I20040810001002 |
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