Provider Demographics
NPI:1114745817
Name:LIGHTFOOT, MARY C (LMHC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2605
Mailing Address - Country:US
Mailing Address - Phone:336-558-5562
Mailing Address - Fax:
Practice Address - Street 1:29 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2605
Practice Address - Country:US
Practice Address - Phone:336-558-5562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013167101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health