Provider Demographics
NPI:1598827941
Name:RICHARD J. LALLY, L.C.S.W., L.L.C.
Entity Type:Organization
Organization Name:RICHARD J. LALLY, L.C.S.W., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LALLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-625-8479
Mailing Address - Street 1:17 PLAYER PL
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-4714
Mailing Address - Country:US
Mailing Address - Phone:973-252-0543
Mailing Address - Fax:973-252-6837
Practice Address - Street 1:40 BLOOMFIELD AVENUE
Practice Address - Street 2:SUITE 5
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-5701
Practice Address - Country:US
Practice Address - Phone:973-625-8479
Practice Address - Fax:973-625-8479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047863001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty