Healthcare Provider Details

I. General information

NPI: 1780782052
Provider Name (Legal Business Name): JEANNE MARIE LIGHTFOOT LCSW LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 STATE STREET
SHELBURNE FALLS MA
01370
US

IV. Provider business mailing address

5 STATE STREET
SHELBURNE FALLS MA
01370
US

V. Phone/Fax

Practice location:
  • Phone: 413-625-2828
  • Fax:
Mailing address:
  • Phone: 413-625-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR043647
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107895
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: