1194746206 NPI number — LAWRENCE J CIVALE LICSW

Table of content: LAWRENCE J CIVALE LICSW (NPI 1194746206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194746206 NPI number — LAWRENCE J CIVALE LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIVALE
Provider First Name:
LAWRENCE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194746206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 HANSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02118-3603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-947-3261
Provider Business Mailing Address Fax Number:
617-451-0803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 W SQUANTUM ST
Provider Second Line Business Practice Location Address:
SUITE 21
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02171-2122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-947-3261
Provider Business Practice Location Address Fax Number:
617-451-0803
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW 110606-1 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com