Provider Demographics
NPI:1366865305
Name:JALLOH, WURIE (LCSW)
Entity Type:Individual
Prefix:
First Name:WURIE
Middle Name:
Last Name:JALLOH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:WURIE
Other - Middle Name:
Other - Last Name:JALLOH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:69 N COMMON ST # 23
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-4312
Mailing Address - Country:US
Mailing Address - Phone:857-312-8639
Mailing Address - Fax:857-415-2182
Practice Address - Street 1:69 N COMMON ST # 23
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-4312
Practice Address - Country:US
Practice Address - Phone:857-312-8639
Practice Address - Fax:857-415-2182
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2167771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical