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General NPI Number Information
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NPI Number | 1598827941
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Entity Type | Organization
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Legal Business Name | RICHARD J. LALLY, L.C.S.W., L.L.C.
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 40 BLOOMFIELD AVENUE SUITE 5
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City | DENVILLE
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State | NJ
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Zip | 07834-5701
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Country | US
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Telephone | 973-625-8479
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Fax | 973-625-8479
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Provider Business Mailing Address
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Address Line | 17 PLAYER PL
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City | FLANDERS
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State | NJ
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Zip | 07836-4714
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Country | US
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Telephone | 973-252-0543
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Fax | 973-252-6837
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICHARD JOSEPH LALLY
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Credential | L.C.S.W.
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Telephone | 973-625-8479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC04786300
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License Number State | NJ
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