Healthcare Provider Details

I. General information

NPI: 1619108321
Provider Name (Legal Business Name): MARIBETH PARENT LALLI LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 OLD BRIDGE RD
HANOVER MA
02339-2331
US

IV. Provider business mailing address

19 OLD BRIDGE RD
HANOVER MA
02339-2331
US

V. Phone/Fax

Practice location:
  • Phone: 781-826-5753
  • Fax:
Mailing address:
  • Phone: 781-826-5753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1015370
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: