Provider Demographics
NPI:1730402637
Name:INSTITUTE FOR LIFE ENRICHMENT
Entity type:Organization
Organization Name:INSTITUTE FOR LIFE ENRICHMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-291-5009
Mailing Address - Street 1:7852 16TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1200
Mailing Address - Country:US
Mailing Address - Phone:202-291-5009
Mailing Address - Fax:
Practice Address - Street 1:5600 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2903
Practice Address - Country:US
Practice Address - Phone:443-444-3848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD773211202Medicaid