Provider Demographics
NPI:1194400697
Name:LIGHTHOUSE PSYCHOTHERAPY AND COACHING LLC
Entity type:Organization
Organization Name:LIGHTHOUSE PSYCHOTHERAPY AND COACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FARGNOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-885-5102
Mailing Address - Street 1:160 WINDERMERE AVE APT 3907
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3942
Mailing Address - Country:US
Mailing Address - Phone:631-885-5102
Mailing Address - Fax:
Practice Address - Street 1:24 BATTLE ST STE 2A
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:CT
Practice Address - Zip Code:06071-1629
Practice Address - Country:US
Practice Address - Phone:860-863-6888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty