NPIMap

Organization Active NPI

Life Span Psychological Services PC

  • Clinical Psychologist
  • Willow Street, PA
National Provider Identifier
1912958356
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS006874L Issued in PA
Legal business name
LIFE SPAN PSYCHOLOGICAL SERVICES PC
Practice address
28190 Willow St PK
Willow Street, PA 17584
Phone
(717) 464-1464
Fax
(717) 464-4348
NPI assigned
May 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Dr. Lynnette G Ruch, PHDNPI 1629014741
Title
PHD
Phone
(717) 464-1464

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YP2500X PC002382 PA
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X PS006874L PA Primary
Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 104100000X SW011339L PA
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X SW123210L PA

Addresses

Primary practice location

28190 Willow St PK
Willow Street, PA 17584

Mailing address

28190 Willow St PK
Willow Street, PA 17584
Phone (717) 464-1464

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050422000044 PA Part B Supplier - Clinic/Group Practice 6305884057 Receives reassigned benefits from 1 practitioner
Practice locations: Lancaster, PA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1912958356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28190 WILLOW ST PK",
            "city": "WILLOW STREET",
            "state": "PA",
            "postal_code": "17584",
            "telephone_number": "717-464-1464",
            "fax_number": "717-464-4348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28190 WILLOW ST PK",
            "city": "WILLOW STREET",
            "state": "PA",
            "postal_code": "17584",
            "telephone_number": "717-464-1464",
            "fax_number": "717-464-4348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SPAN PSYCHOLOGICAL SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "RUCH",
        "authorized_official_first_name": "LYNNETTE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PHD",
        "authorized_official_telephone_number": "717-464-1464",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC002382",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS006874L",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "PA",
            "license": "SW011339L",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "SW123210L",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willow Street, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.