| Lighthouse Integrative Counseling Services Lcsw Marriage And Family Th | |
|
414 Main St Ste 203a Port Jefferson NY 11777-1686 | |
| (631) 478-3292 | |
| (631) 476-1302 |
| Full Name | Lighthouse Integrative Counseling Services Lcsw Marriage And Family Th |
|---|---|
| Speciality | Social Worker |
| Location | 414 Main St Ste 203a, Port Jefferson, New York |
| Authorized Official Name and Position | Michelle D Conelli (FOUNDER/DIRECTOR) |
| Authorized Official Contact | 6314783292 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Integrative Counseling Services Lcsw Marriage And Family Th 414 Main St Ste 203a Port Jefferson NY 11777-1686 Ph: (631) 478-3292 | Lighthouse Integrative Counseling Services Lcsw Marriage And Family Th 414 Main St Ste 203a Port Jefferson NY 11777-1686 Ph: (631) 478-3292 |
| NPI Number | 1699135566 |
|---|---|
| Provider Enumeration Date | 03/04/2016 |
| Last Update Date | 03/04/2016 |
| Medicare PECOS PAC ID | 0840664561 |
|---|---|
| Medicare Enrollment ID | O20230321001046 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699135566 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 073603 (New York) | Primary |
| 106H00000X | Marriage & Family Therapist | 000230 (New York) | Secondary |
| Provider Name | Michelle Conelli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467590828 PECOS PAC ID: 2062503659 Enrollment ID: I20070810000772 |
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