Provider Demographics
NPI:1518940444
Name:FOLLY, RICHARD D (LICSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:FOLLY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PRINCETON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1558
Mailing Address - Country:US
Mailing Address - Phone:978-256-6579
Mailing Address - Fax:978-256-1943
Practice Address - Street 1:73 PRINCETON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1558
Practice Address - Country:US
Practice Address - Phone:978-256-6579
Practice Address - Fax:978-256-1943
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10229331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA004552OtherVALUE OPTIONS
NH14Y008272MA01OtherBCBSNH
MA1859145Medicaid
MA291365000OtherMAGELLAN
MA467484OtherTUFTS
MA043476807-14OtherPACIFICARE
NH14Y008272MA01OtherBCBSNH