MEDICARE: LIGHTHOUSE WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1558238394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE WELLNESS, LLC

Provider Business Mailing Address
First Line	:	12 BIRET DR
Second Line	:
City	:	AIRMONT
State	:	NY
Zip	:	10952-4101
Country	:	US
Telephone Number	:	718-208-7780
Fax Number	:

Provider Business Practice Location Address
First Line	:	178 WALWORTH ST STE 410
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-4365
Country	:	US
Telephone Number	:	718-208-7780
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	JACOB LICHTMAN
Credential	:	LMHC
Telephone Number	:	718-208-7780

Provider Enumeration Date	:	10/17/2025
Last Update Date	:	10/17/2025

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