1972665487 NPI number — MR. RICHARD LALLY JOSEPH LALLY L.C.S.W.

Table of content: MR. RICHARD LALLY JOSEPH LALLY L.C.S.W. (NPI 1972665487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972665487 NPI number — MR. RICHARD LALLY JOSEPH LALLY L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LALLY
Provider First Name:
RICHARD LALLY
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
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:
1972665487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 PLAYER PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLANDERS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07836-4714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-252-0543
Provider Business Mailing Address Fax Number:
973-252-6837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 BLOOMFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
DENVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07834-5701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-625-8479
Provider Business Practice Location Address Fax Number:
973-252-6837
Provider Enumeration Date:
12/14/2006

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:  44SC04786300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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