Provider Demographics
NPI:1801175955
Name:SERENITY LIFE MANAGEMENT GROUP
Entity type:Organization
Organization Name:SERENITY LIFE MANAGEMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEVENS-YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:412-583-7892
Mailing Address - Street 1:371 DOROTHY DR
Mailing Address - Street 2:
Mailing Address - City:PENN HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15235-1831
Mailing Address - Country:US
Mailing Address - Phone:412-583-7892
Mailing Address - Fax:
Practice Address - Street 1:9816 FRANKSTOWN RD
Practice Address - Street 2:LOWER LEVEL SUITE
Practice Address - City:PENN HILLS
Practice Address - State:PA
Practice Address - Zip Code:15235-1654
Practice Address - Country:US
Practice Address - Phone:412-583-7892
Practice Address - Fax:412-241-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW015959251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016115230003Medicaid