Healthcare Provider Details

I. General information

NPI: 1891519062
Provider Name (Legal Business Name): THE LIGHTHOUSE PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 BROADWAY STE R
ALBANY NY
12207-2922
US

IV. Provider business mailing address

537 WHITNEY AVE APT 1
NEW HAVEN CT
06511-7707
US

V. Phone/Fax

Practice location:
  • Phone: 475-273-2431
  • Fax:
Mailing address:
  • Phone: 203-298-2177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. URI BERGER
Title or Position: OWNER
Credential: PH.D.
Phone: 203-298-2177