| Lifespan Counseling Center Llc | |
|
729 Grove Ave Suite 3 Southampton PA 18966-6008 | |
| (215) 355-8812 | |
| (215) 355-0926 |
| Full Name | Lifespan Counseling Center Llc |
|---|---|
| Speciality | Psychologist |
| Location | 729 Grove Ave, Southampton, Pennsylvania |
| Authorized Official Name and Position | Andrea Sywulak Mannino (OWNER) |
| Authorized Official Contact | 2153558812 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifespan Counseling Center Llc 729 Grove Ave Suite 3 Southampton PA 18966-6008 Ph: (215) 355-8812 | Lifespan Counseling Center Llc 729 Grove Ave Suite 3 Southampton PA 18966-6008 Ph: (215) 355-8812 |
| NPI Number | 1104287564 |
|---|---|
| Provider Enumeration Date | 03/14/2016 |
| Last Update Date | 03/14/2016 |
| Medicare PECOS PAC ID | 8729377999 |
|---|---|
| Medicare Enrollment ID | O20160512000403 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104287564 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PA-003501-L (Pennsylvania) | Primary |
| Provider Name | Andrea E Sywulak Mannino |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1427261189 PECOS PAC ID: 0941468714 Enrollment ID: I20160726000688 |
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