Healthcare Provider Details

I. General information

NPI: 1396002010
Provider Name (Legal Business Name): JAMES THOMAS LAHEY I LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 JOHNSON AVE
RONKONKOMA NY
11779-6066
US

IV. Provider business mailing address

6 BROADWAY
SMITHTOWN NY
11787-4602
US

V. Phone/Fax

Practice location:
  • Phone: 631-471-7242
  • Fax: 631-471-5150
Mailing address:
  • Phone: 631-361-7859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005110-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: