Provider Demographics
NPI:1588177653
Name:HALL, GEORGE LINDSEY
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:LINDSEY
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MINOTS ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1803
Mailing Address - Country:US
Mailing Address - Phone:774-386-1430
Mailing Address - Fax:
Practice Address - Street 1:411 CHANDLER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3339
Practice Address - Country:US
Practice Address - Phone:508-799-0688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA775970237OtherTUFT NAVIGATOR