Provider Demographics
NPI:1235754037
Name:LMWALL, LICSW, CADC-II, LLC
Entity Type:Organization
Organization Name:LMWALL, LICSW, CADC-II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, CADC-II
Authorized Official - Phone:413-320-1751
Mailing Address - Street 1:120 DUNPHY DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-9602
Mailing Address - Country:US
Mailing Address - Phone:413-320-1751
Mailing Address - Fax:413-327-9523
Practice Address - Street 1:120 DUNPHY DRIVE
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01062-9602
Practice Address - Country:US
Practice Address - Phone:413-320-1751
Practice Address - Fax:413-327-9523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty