Healthcare Provider Details

I. General information

NPI: 1841502085
Provider Name (Legal Business Name): LYNDSEY M KILLILEA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2010
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CHELMSFORD ST
CHELMSFORD MA
01824-2359
US

IV. Provider business mailing address

201 CHELMSFORD ST
CHELMSFORD MA
01824-2359
US

V. Phone/Fax

Practice location:
  • Phone: 978-256-1467
  • Fax:
Mailing address:
  • Phone: 978-256-1467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number699884
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: