Lifetime Optimization, Inc.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2227 Issued in OR

Legal business name

LIFETIME OPTIMIZATION, INC.

Practice address

6105 SW Macadam Ave Ste 100
Portland, OR 97239-3640

Phone

(503) 327-8713

NPI assigned

Mar 13, 2013

Last updated

Mar 13, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Bradley Royce Pendergraft, LCSWNPI 1386984854

Title

President

Phone

(503) 327-8713

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bradley Royce Pendergraft, LCSW

  • Clinical Social Worker
  • Portland, OR
  • NPI 1386984854
  NPD (past) Authorized official

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

{
    "created_epoch": "1363132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363132800000",
    "number": "1700127941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6105 SW MACADAM AVE STE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393640",
            "telephone_number": "503-327-8713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6105 SW MACADAM AVE STE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393640",
            "telephone_number": "503-327-8713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME OPTIMIZATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-13",
        "last_updated": "2013-03-13",
        "status": "A",
        "authorized_official_last_name": "PENDERGRAFT",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "ROYCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-327-8713",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "2227",
            "primary": true
        },
        {
            "code": "246ZE0500X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, EEG",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lifeworks Northwest
• Lifeworks Northwest
• Lifeworks Northwest
• Lifeworks NW

• Clinical Social Worker in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2013; 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.