Provider Demographics
NPI:1972665487
Name:LALLY, RICHARD LALLY JOSEPH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD LALLY
Middle Name:JOSEPH
Last Name:LALLY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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 AVE
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:973-252-6837
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047863001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical