Provider Demographics
NPI:1073395869
Name:LIGHTWORK THERAPY, PLLC
Entity Type:Organization
Organization Name:LIGHTWORK THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROHE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:315-753-8710
Mailing Address - Street 1:264 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOUVERNEUR
Mailing Address - State:NY
Mailing Address - Zip Code:13642-1333
Mailing Address - Country:US
Mailing Address - Phone:315-753-8710
Mailing Address - Fax:
Practice Address - Street 1:264 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GOUVERNEUR
Practice Address - State:NY
Practice Address - Zip Code:13642-1333
Practice Address - Country:US
Practice Address - Phone:315-753-8710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty