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LIFE FULLY LIVED LLC
Mental Health

NPI Profile for LIFE FULLY LIVED LLC in TALLEYVILLE, DE.

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Contact Information

LIFE FULLY LIVED, LLC
19 BRANDYWINE BLVD
TALLEYVILLE, DE  19803-1838
 Phone: 302-703-7779
 Fax:
 Website:
 

Specialty

 Taxonomy Code Specialty Code Provider Type

Mental Health

 101YM0800X
 

Clinical

 1041C0700X 80 Licensed Clinical Social Worker
 

Nurse Practitioner

 363L00000X 50 Nurse Practitioner
 

Psychologist

 103T00000X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for LIFE FULLY LIVED LLC · (Female)

NPI # 1003408352
Status Active
Credentials
Entity Individual
Enumeration date 02/08/2021
Last updated 12/24/2023 - About 2 years ago
Sole proprietor 1 Not specified
Identifiers
  • DE Medicaid 1023361136
  • DE Medicaid 1093300527
  • DE Medicaid 1124693056
  • DE Medicaid 1134272610
  • DE Medicaid 1134488711
  • DE Medicaid 1275287823
  • DE Medicaid 1366405433
  • DE Medicaid 1538734959
  • DE Medicaid 1891379467
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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