Provider Demographics
NPI:1033086459
Name:LIGHTPATH WELLNESS LLC
Entity type:Organization
Organization Name:LIGHTPATH WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP
Authorized Official - Phone:917-570-0426
Mailing Address - Street 1:216 PURCHASE ST APT M
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2149
Mailing Address - Country:US
Mailing Address - Phone:917-570-0426
Mailing Address - Fax:
Practice Address - Street 1:150 RIVERSIDE PKWY FL 1
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-1094
Practice Address - Country:US
Practice Address - Phone:917-570-0426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health