Provider Demographics
NPI:1689207748
Name:LIGHTHOUSE PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE PSYCHOTHERAPY LLC
Other - Org Name:LIGHTHOUSE PSYCHOTHERAPY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-757-1296
Mailing Address - Street 1:297 KINDERKAMACK RD STE 298
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1538
Mailing Address - Country:US
Mailing Address - Phone:718-757-1296
Mailing Address - Fax:
Practice Address - Street 1:297 KINDERKAMACK RD STE 298
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1538
Practice Address - Country:US
Practice Address - Phone:718-757-1296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty