# LIFESPAN COLLABORATIVE SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013395466
- **Authorized official:** DILICE ROBERTSON DNP-APRN (MEMBER)
- **Authorized official phone:** (203) 887-1278

## Contact information

- **Practice address:** 71 OXFORD RD, OXFORD, CT 06478-1900
- **Practice address phone:** (203) 463-4558
- **Mailing address:** 2390 STATE ST, UNIT 2E, HAMDEN, CT 06517-3716
- **Mailing address phone:** (203) 887-1278

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 003973 | CT | Yes |

## Other

- **Enumeration date:** 05/18/2015
- **Last updated:** 05/18/2015