| Organization Name: | LIFE THERAPY SPECIALISTS OF MD, LLC |
| NPI Number: | 1114225810 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARIE E MASTRACCO (PRESIDENT) |
| Mailing Address: | 1927a York Rd Lutherville |
| State: | MD US |
| Postal Code: | 210934225 |
| Phone Number: | 4434174243 |
| Fax Number: | 3152450352 |
| NPI Enumeration Date: | 03/03/2011 |
| NPI Last Update Date: | 03/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LC2273 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |