MEDICARE: MR. DANIEL LIGHTELL JR. LCSW

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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker
3	1041C0700X	Clinical Social Worker	14546	LA

General Provider Information

NPI Number	:	1528578705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL LIGHTELL JR. LCSW

Provider Business Mailing Address
First Line	:	753 3RD AVE
Second Line	:
City	:	HARVEY
State	:	LA
Zip	:	70058-2601
Country	:	US
Telephone Number	:	504-214-9055
Fax Number	:

Provider Business Practice Location Address
First Line	:	753 3RD AVE
Second Line	:
City	:	HARVEY
State	:	LA
Zip	:	70058-2601
Country	:	US
Telephone Number	:	504-214-9055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	06/02/2025

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