Provider Demographics
NPI:1902068950
Name:LIFE STRATEGIES
Entity Type:Organization
Organization Name:LIFE STRATEGIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOURDINE
Authorized Official - Suffix:
Authorized Official - Credentials:APN C
Authorized Official - Phone:201-224-5200
Mailing Address - Street 1:83 SUMMIT AVE
Mailing Address - Street 2:2ND FLR
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-224-5200
Mailing Address - Fax:201-224-0599
Practice Address - Street 1:83 SUMMIT AVE
Practice Address - Street 2:2ND FLR
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1262
Practice Address - Country:US
Practice Address - Phone:201-224-5200
Practice Address - Fax:201-224-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00080100261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)