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Organization
LIGHTHOUSE INTEGRATIVE COUNSELING SERVICES LCSW MARRIAGE AND FAMILY TH
Active
Organization
LIGHTHOUSE INTEGRATIVE COUNSELING SERVICES LCSW MARRIAGE AND FAMILY TH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE D CONELLI LCSW, LMFT (FOUNDER/DIRECTOR)
(631) 478-3292
Entity
Organization
Contact information
Practice address
414 MAIN ST STE 203A, PORT JEFFERSON, NY 11777-1686
(631) 478-3292
(631) 476-1302
Mailing address
414 MAIN ST STE 203A, PORT JEFFERSON, NY 11777-1686
(631) 478-3292
(631) 476-1302
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
073603
NY
106H00000X
Marriage & Family Therapist
000230
NY
Other
Enumeration date
03/04/2016
Last updated
03/04/2016
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