Provider Demographics
NPI:1104977685
Name:LALLI, KEVIN (LMHC)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:LALLI
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SOUTH ST
Mailing Address - Street 2:#8
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5167
Mailing Address - Country:US
Mailing Address - Phone:617-686-3871
Mailing Address - Fax:781-871-0306
Practice Address - Street 1:200 CORDWAINER DR
Practice Address - Street 2:SUITE 202
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1671
Practice Address - Country:US
Practice Address - Phone:617-686-3871
Practice Address - Fax:781-871-0306
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health