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General NPI Number Information
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NPI Number | 1881965747
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Entity Type | Organization
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Legal Business Name | LIGHTED PATHWAYS, LLC
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Dates
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Enumeration Date | 01/24/2012
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Last Update Date | 05/10/2012
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Provider Practice Location Address
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Address Line | 480 BROADWAY SUITE 330
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-2230
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Country | US
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Telephone | 518-587-0268
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Fax |
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Provider Business Mailing Address
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Address Line | 480 BROADWAY SUITE 330
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-2230
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Country | US
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Telephone | 518-587-0268
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JENNY OLIN
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Credential | LCSW
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Telephone | 518-587-0268
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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 | R026827-1
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License Number State | NY
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