MEDICARE: NEW LIGHT THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1144882283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIGHT THERAPY, LLC

Provider Business Mailing Address
First Line	:	7858 PARSONS PINE DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-7528
Country	:	US
Telephone Number	:	561-699-7708
Fax Number	:

Provider Business Practice Location Address
First Line	:	7858 PARSONS PINE DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-7528
Country	:	US
Telephone Number	:	561-699-7708
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	RENEE TONG
Credential	:	LCSW
Telephone Number	:	561-699-7708

Provider Enumeration Date	:	06/28/2019
Last Update Date	:	06/28/2019

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Directions to “NEW LIGHT THERAPY, LLC ” Practice Location

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