Provider Demographics
NPI:1093833048
Name:GAEV, LILLY (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:
First Name:LILLY
Middle Name:
Last Name:GAEV
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THERAPEUTIC ASSOCIATES PC
Mailing Address - Street 2:167 DWIGHT RD #104
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106
Mailing Address - Country:US
Mailing Address - Phone:413-567-5533
Mailing Address - Fax:413-567-9010
Practice Address - Street 1:THERAPEUTIC ASSOCIATES PC
Practice Address - Street 2:167 DWIGHT RD #104
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106
Practice Address - Country:US
Practice Address - Phone:413-567-5533
Practice Address - Fax:413-567-9010
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2035481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical