Provider Demographics
NPI:1336505155
Name:LIGHT, PATRICIA (EDD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:LIGHT
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 DUNBARTON RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2458
Mailing Address - Country:US
Mailing Address - Phone:617-484-1698
Mailing Address - Fax:
Practice Address - Street 1:31 DUNBARTON RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-2458
Practice Address - Country:US
Practice Address - Phone:617-484-1698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA419103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling