Provider Demographics
NPI:1780782052
Name:LIGHTFOOT, JEANNE MARIE (LCSW LICSW)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:MARIE
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:LCSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01370
Mailing Address - Country:US
Mailing Address - Phone:413-625-2828
Mailing Address - Fax:
Practice Address - Street 1:5 STATE STREET
Practice Address - Street 2:
Practice Address - City:SHELBURNE FALLS
Practice Address - State:MA
Practice Address - Zip Code:01370
Practice Address - Country:US
Practice Address - Phone:413-625-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0436471041C0700X
MA1078951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07547OtherBCBS MA
MA1857479Medicaid
MA1857479Medicaid
MAP20907Medicare ID - Type Unspecified