Provider Demographics
NPI:1275957573
Name:DALAL, VIJAY V (MSW, MBA, LICSW)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:V
Last Name:DALAL
Suffix:
Gender:M
Credentials:MSW, MBA, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 ROBERT RD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-6527
Mailing Address - Country:US
Mailing Address - Phone:617-631-3067
Mailing Address - Fax:
Practice Address - Street 1:15 MILLWOOD CIR
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-3732
Practice Address - Country:US
Practice Address - Phone:617-631-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1031456101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health