Provider Demographics
NPI:1346566650
Name:LIFE BALANCE
Entity type:Organization
Organization Name:LIFE BALANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:PRETE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-982-4418
Mailing Address - Street 1:408 HIGHLAND AVE
Mailing Address - Street 2:BUILDING A OFFICE #8
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2525
Mailing Address - Country:US
Mailing Address - Phone:203-982-4418
Mailing Address - Fax:
Practice Address - Street 1:408 HIGHLAND AVE
Practice Address - Street 2:BUILDING A OFFICE #8
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2525
Practice Address - Country:US
Practice Address - Phone:203-982-4418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001671101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1013067354OtherNPI TYPE 1