Provider Demographics
NPI:1609808344
Name:LALLY, DINA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:LYNN
Last Name:LALLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 SWEET ARROW LAKE RD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-8712
Mailing Address - Country:US
Mailing Address - Phone:570-573-0247
Mailing Address - Fax:570-621-9888
Practice Address - Street 1:396 S CENTRE ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3596
Practice Address - Country:US
Practice Address - Phone:570-573-0247
Practice Address - Fax:570-621-9888
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0160591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical