Provider Demographics
NPI:1841925922
Name:FIRST LIGHT THERAPY LLC
Entity type:Organization
Organization Name:FIRST LIGHT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-758-4624
Mailing Address - Street 1:PO BOX 6188
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-7204
Mailing Address - Country:US
Mailing Address - Phone:978-852-4758
Mailing Address - Fax:
Practice Address - Street 1:258 NEWARK ST STE 208
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-3418
Practice Address - Country:US
Practice Address - Phone:908-758-4624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)