Provider Demographics
NPI:1629382411
Name:LIGHTHALL, VALERIE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:LIGHTHALL
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:NESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:10 NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1308
Mailing Address - Country:US
Mailing Address - Phone:315-515-4445
Mailing Address - Fax:
Practice Address - Street 1:10 NORTON AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1308
Practice Address - Country:US
Practice Address - Phone:315-515-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081947-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04154358Medicaid
NYJ400225355Medicare PIN