Lifespan Counseling Center LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PA-003501-L Issued in PA

Legal business name

LIFESPAN COUNSELING CENTER LLC

Practice address

729 Grove Ave
Suite 3
Southampton, PA 18966-6008

Phone

(215) 355-8812

Fax

(215) 355-0926

NPI assigned

Mar 14, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Andrea Sywulak Mannino, PH.D.

Title

Owner

Phone

(215) 355-8812

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457913600000",
    "number": "1104287564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "729 GROVE AVE",
            "address_2": "SUITE 3",
            "city": "SOUTHAMPTON",
            "state": "PA",
            "postal_code": "189666008",
            "telephone_number": "215-355-8812",
            "fax_number": "215-355-0926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "729 GROVE AVE",
            "address_2": "SUITE 3",
            "city": "SOUTHAMPTON",
            "state": "PA",
            "postal_code": "189666008",
            "telephone_number": "215-355-8812",
            "fax_number": "215-355-0926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN COUNSELING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-14",
        "last_updated": "2016-03-14",
        "status": "A",
        "authorized_official_last_name": "MANNINO",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "SYWULAK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-355-8812",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PA-003501-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Southampton, PA
• Providers in Southampton, PA by specialty
• Clinical Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.