Provider Demographics
NPI:1174887152
Name:THE LAMPLIGHTER CENTER FOR RENEWAL, INC.
Entity type:Organization
Organization Name:THE LAMPLIGHTER CENTER FOR RENEWAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-583-9800
Mailing Address - Street 1:820 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4411
Mailing Address - Country:US
Mailing Address - Phone:508-583-9800
Mailing Address - Fax:508-583-9802
Practice Address - Street 1:820 PEARL ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4411
Practice Address - Country:US
Practice Address - Phone:508-583-9800
Practice Address - Fax:508-583-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAB56529251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health