MEDICARE: MS. MARIBETH PARENT LALLI LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	1015370	MA

General Provider Information

NPI Number	:	1619108321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIBETH PARENT LALLI LICSW

Provider Business Mailing Address
First Line	:	19 OLD BRIDGE RD
Second Line	:
City	:	HANOVER
State	:	MA
Zip	:	02339-2331
Country	:	US
Telephone Number	:	781-826-5753
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 OLD BRIDGE RD
Second Line	:
City	:	HANOVER
State	:	MA
Zip	:	02339-2331
Country	:	US
Telephone Number	:	781-826-5753
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	07/29/2009

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