Provider Demographics
NPI:1154769917
Name:LIFESPAN HEALTH NETWORK, A PSYCHOLOGY CORPORATION
Entity type:Organization
Organization Name:LIFESPAN HEALTH NETWORK, A PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:AROM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-739-1167
Mailing Address - Street 1:1171 S ROBERTSON BLVD
Mailing Address - Street 2:SUITE 415
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1403
Mailing Address - Country:US
Mailing Address - Phone:310-248-4949
Mailing Address - Fax:
Practice Address - Street 1:9171 WILSHIRE BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5530
Practice Address - Country:US
Practice Address - Phone:310-248-4949
Practice Address - Fax:310-248-4832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty