Provider Demographics
NPI:1992074751
Name:LIFESKILLS & PSYCHOTHERAPY SERVICES,PC
Entity type:Organization
Organization Name:LIFESKILLS & PSYCHOTHERAPY SERVICES,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:O
Authorized Official - Last Name:SEAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, BCD,
Authorized Official - Phone:631-648-7689
Mailing Address - Street 1:18 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2244
Mailing Address - Country:US
Mailing Address - Phone:631-648-7689
Mailing Address - Fax:631-648-7690
Practice Address - Street 1:18 FOREST RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2244
Practice Address - Country:US
Practice Address - Phone:631-648-7689
Practice Address - Fax:631-648-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
NYR0270991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty