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General NPI Number Information
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NPI Number | 1982404919
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Entity Type | Organization
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Legal Business Name | J D BIENENFELD MSW LICENSED CLINICAL SOCIAL WORKERC CORP LIGHTHOUSE PSYCHOTHERAPY
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 11122 RIVERSIDE DR UNIT 101
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City | WEST TOLUCA LAKE
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State | CA
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Zip | 91602-2186
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Country | US
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Telephone | 818-430-2792
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Fax |
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Provider Business Mailing Address
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Address Line | 4365 E LOWELL ST STE H
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City | ONTARIO
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State | CA
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Zip | 91761-2226
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Country | US
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Telephone | 818-430-2792
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOSHUA DAVID BIENENFELD
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Credential | MSW
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Telephone | 818-430-2792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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