Provider Demographics
NPI:1417737834
Name:LIGHTWORKS PSYCHIATRIC SERVICES, INC
Entity Type:Organization
Organization Name:LIGHTWORKS PSYCHIATRIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TETZLAFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-304-8633
Mailing Address - Street 1:552 S LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003-2137
Mailing Address - Country:US
Mailing Address - Phone:717-304-8633
Mailing Address - Fax:
Practice Address - Street 1:552 S LANCASTER ST
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003-2137
Practice Address - Country:US
Practice Address - Phone:717-304-8633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty