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General NPI Number Information
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NPI Number | 1780439653
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Entity Type | Individual
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Provider Name | ERICH LICHTENWALTER LMSW
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Gender | Male
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Dates
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Enumeration Date | 04/23/2024
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Last Update Date | 03/01/2025
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Provider Practice Location Address
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Address Line | 133 W MAIN ST
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City | BENTON HARBOR
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State | MI
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Zip | 49022-3607
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Country | US
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Telephone | 269-408-2258
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Fax | 989-352-6435
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Provider Business Mailing Address
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Address Line | 4709 TIMBERLAND DR
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City | BERRIEN SPRINGS
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State | MI
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Zip | 49103-1430
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Country | US
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Telephone | 269-861-4287
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6801119795
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License Number State | MI
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