Provider Demographics
NPI:1124031513
Name:VALLELI, AMY R (MSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:R
Last Name:VALLELI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HOWE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5910
Mailing Address - Country:US
Mailing Address - Phone:617-922-2260
Mailing Address - Fax:
Practice Address - Street 1:1350 HANCOCK STREET
Practice Address - Street 2:#304
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-745-4100
Practice Address - Fax:617-745-4170
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MA1156291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical