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General NPI Number Information
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NPI Number | 1891519062
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Entity Type | Organization
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Legal Business Name | THE LIGHTHOUSE PSYCHOLOGICAL SERVICES PLLC
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 418 BROADWAY STE R
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City | ALBANY
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State | NY
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Zip | 12207-2922
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Country | US
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Telephone | 475-273-2431
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Fax |
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Provider Business Mailing Address
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Address Line | 537 WHITNEY AVE APT 1
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City | NEW HAVEN
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State | CT
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Zip | 06511-7707
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Country | US
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Telephone | 203-298-2177
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. URI BERGER
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Credential | PH.D.
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Telephone | 203-298-2177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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