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NPI Code Detail

MEDICARE: MRS. LACI LUCILLE GENTRY LCSW

MEDICARE:  MRS. LACI LUCILLE GENTRY  LCSW
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 Worker214386MA

General Provider Information

NPI Number : 1457540866
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LACI LUCILLE GENTRY LCSW
Provider Business Mailing Address
First Line : 40 BELMONT ST # 1
Second Line :
City : SOMERVILLE
State : MA
Zip : 02143-2535
Country : US
Telephone Number : 502-298-2799
Fax Number :
Provider Business Practice Location Address
First Line : 555 AMORY ST
Second Line :
City : JAMAICA PLAIN
State : MA
Zip : 02130-2652
Country : US
Telephone Number : 617-522-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2007
Last Update Date : 10/22/2007

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Directions to “ MRS. LACI LUCILLE GENTRY LCSW” Practice Location

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