NPIMap

Organization Active NPI

Lighthouse Integrative Counseling Services LCSW Marriage and Family TH

  • Clinical Social Worker
  • Port Jefferson, NY
National Provider Identifier
1699135566
Registry record updated Mar 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
073603 Issued in NY
Legal business name
LIGHTHOUSE INTEGRATIVE COUNSELING SERVICES LCSW MARRIAGE AND FAMILY TH
Practice address
414 Main St Ste 203a
Port Jefferson, NY 11777-1686
Phone
(631) 478-3292
Fax
(631) 476-1302
NPI assigned
Mar 4, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michelle D Conelli, LCSW, LMFTNPI 1467590828
Title
Founder/Director
Phone
(631) 478-3292

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 073603 NY Primary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X 000230 NY

Addresses

Primary practice location

414 Main St Ste 203a
Port Jefferson, NY 11777-1686

Mailing address

414 Main St Ste 203a
Port Jefferson, NY 11777-1686
Phone (631) 478-3292

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230321001046 NY Part B Supplier - Clinic/Group Practice 0840664561 Receives reassigned benefits from 6 practitioners
Practice locations: Port Jefferson Station, NY

National Provider Directory

National Provider Directory

Locations

414 Main St
Ste 203A
Port Jefferson, NY 11777
Phone (631) 478-3292

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457049600000",
    "number": "1699135566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 MAIN ST STE 203A",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771686",
            "telephone_number": "631-478-3292",
            "fax_number": "631-476-1302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 MAIN ST STE 203A",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771686",
            "telephone_number": "631-478-3292",
            "fax_number": "631-476-1302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE INTEGRATIVE COUNSELING SERVICES LCSW MARRIAGE AND FAMILY TH",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-04",
        "last_updated": "2016-03-04",
        "status": "A",
        "authorized_official_last_name": "CONELLI",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "FOUNDER/DIRECTOR",
        "authorized_official_telephone_number": "631-478-3292",
        "authorized_official_credential": "LCSW, LMFT"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "073603",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "NY",
            "license": "000230",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.