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General NPI Number Information
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NPI Number | 1194400697
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE PSYCHOTHERAPY AND COACHING LLC
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 24 BATTLE ST STE 2A
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City | SOMERS
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State | CT
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Zip | 06071-1629
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Country | US
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Telephone | 860-863-6888
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Fax |
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Provider Business Mailing Address
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Address Line | 160 WINDERMERE AVE APT 3907
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City | ELLINGTON
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State | CT
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Zip | 06029-3942
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Country | US
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Telephone | 631-885-5102
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA M FARGNOLI
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Credential |
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Telephone | 631-885-5102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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