Healthcare Provider Details

I. General information

NPI: 1306691035
Provider Name (Legal Business Name): LINDSAY GABRIELLE LIGHTFOOT LCSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4407 QUAIL HOLLOW RD
ORANGE PARK FL
32065-2669
US

IV. Provider business mailing address

4407 QUAIL HOLLOW RD
ORANGE PARK FL
32065-2669
US

V. Phone/Fax

Practice location:
  • Phone: 629-543-9628
  • Fax:
Mailing address:
  • Phone: 629-543-9628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10492
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25780
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: