Provider Demographics
NPI:1619270196
Name:HANLEY, LOLITA M (PSYD, LMHC, LADC-I)
Entity Type:Individual
Prefix:MS
First Name:LOLITA
Middle Name:M
Last Name:HANLEY
Suffix:
Gender:F
Credentials:PSYD, LMHC, LADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HICKOX ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3746
Mailing Address - Country:US
Mailing Address - Phone:347-458-0085
Mailing Address - Fax:
Practice Address - Street 1:125 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1114
Practice Address - Country:US
Practice Address - Phone:347-458-0085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13340101YA0400X
MA10113101YM0800X, 101YP2500X
MA10856103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303295 (MH)Medicaid
MA1307576 (SA)Medicaid
M18463OtherBLUE CROSS / BLUE SHIELD
Y10086Medicare PIN