Provider Demographics
NPI:1477207421
Name:LIGHTLIST PSYCHOLOGICAL SERVICES INC.
Entity Type:Organization
Organization Name:LIGHTLIST PSYCHOLOGICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:351-333-7177
Mailing Address - Street 1:179 GREAT RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5740
Mailing Address - Country:US
Mailing Address - Phone:351-333-7177
Mailing Address - Fax:
Practice Address - Street 1:179 GREAT RD STE 102
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-5740
Practice Address - Country:US
Practice Address - Phone:351-333-7177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty