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NPI Code Detail

MEDICARE: MS. LILLIAN R. STRUCKUS MSW, LICSW

MEDICARE: MS. LILLIAN R. STRUCKUS MSW, 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
11041C0700XClinical Social Worker101929MA

General Provider Information

NPI Number : 1124048731
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LILLIAN R. STRUCKUS MSW, LICSW
Provider Business Mailing Address
First Line : 118 OAK ST
Second Line : APT. #25
City : FLORENCE
State : MA
Zip : 01062-1372
Country : US
Telephone Number : 413-585-0620
Fax Number :
Provider Business Practice Location Address
First Line : 421 NORTH MAIN STREET
Second Line : VA MEDICAL CENTER
City : LEEDS
State : MA
Zip : 01053-9764
Country : US
Telephone Number : 413-584-4040
Fax Number : 413-582-3082
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 07/08/2007

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