Life Revival LLC
NPI 1023701067 · Community/Behavioral Health Agency · Philadelphia, PA
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1023701067
- Entity type
- Organization
- Primary specialty
- Community/Behavioral Health AgencyAgencies
- Organization subpart
- No
- Authorized official
- Daniel Lee, Director(267) 259-4558
Specialties & taxonomies
Agencies
- Mental Health Counselor101YM0800X
Behavioral Health & Social Service Providers
- Counseling Psychologist103TC1900X
Behavioral Health & Social Service Providers
- Family Psychologist103TF0000X
Behavioral Health & Social Service Providers
- Psychoanalysis Psychologist103TP0814X
Behavioral Health & Social Service Providers
- Group Psychotherapy Psychologist103TP2701X
Behavioral Health & Social Service Providers
- Clinical Social Worker1041C0700X
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
3 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Other name
- Life Revival, LLC
Registry dates
- Enumerated
- 2023-05-26
- Last updated
- 2025-02-11
- Certified
- 2025-02-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.