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Organization
LIFETIME CHANGES BEHAVIOR SERVICES LLC
Active
Organization
LIFETIME CHANGES BEHAVIOR SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DANA VAN DYKE M.ED (OWNER/PROGRAM DIRECTOR)
(929) 256-0231
Entity
Organization
Contact information
Practice address
683 HENDERSON AVE STE A, STATEN ISLAND, NY 10310-1575
(929) 256-0231
(718) 732-2628
Mailing address
683 HENDERSON AVE STE A, STATEN ISLAND, NY 10310-1575
(929) 256-0231
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
NULL
251C00000X
Developmentally Disabled Services Day Training Agency
—
NULL
251S00000X
Community/Behavioral Health Agency
—
NULL
252Y00000X
Early Intervention Provider Agency
Primary
—
NULL
261QC1500X
Community Health Clinic/Center
—
NULL
261QD1600X
Developmental Disabilities Clinic/Center
—
NULL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
Other
Enumeration date
04/09/2020
Last updated
05/25/2021
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