MEDICARE: VALERIE LIGHTHALL LCSW-R

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	1041C0700X	Clinical Social Worker	081947-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629382411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE LIGHTHALL LCSW-R

Provider Business Mailing Address
First Line	:	10 NORTON AVE
Second Line	:
City	:	CLINTON
State	:	NY
Zip	:	13323-1308
Country	:	US
Telephone Number	:	315-515-4445
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 NORTON AVE
Second Line	:
City	:	CLINTON
State	:	NY
Zip	:	13323-1308
Country	:	US
Telephone Number	:	315-515-4445
Fax Number	:

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

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	12/03/2025

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