Provider Demographics
NPI:1619108321
Name:LALLI, MARIBETH PARENT (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARIBETH
Middle Name:PARENT
Last Name:LALLI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 OLD BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-2331
Mailing Address - Country:US
Mailing Address - Phone:781-826-5753
Mailing Address - Fax:
Practice Address - Street 1:19 OLD BRIDGE RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-2331
Practice Address - Country:US
Practice Address - Phone:781-826-5753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1015370101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health