Healthcare Provider Details

I. General information

NPI: 1730902891
Provider Name (Legal Business Name): BEACON LIGHT NEUROPSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/23/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 FREE ST STE 404
PORTLAND ME
04101-3900
US

IV. Provider business mailing address

22 FREE ST STE 404
PORTLAND ME
04101-3900
US

V. Phone/Fax

Practice location:
  • Phone: 207-544-6810
  • Fax: 207-544-6888
Mailing address:
  • Phone: 207-544-6810
  • Fax: 207-544-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: CRAIG DIGIOVANNI
Title or Position: OWNER
Credential: PHD
Phone: 860-965-8054