Provider Demographics
NPI:1740363332
Name:FAMILY & CHILDRENS SERVICE OF GR LYNN INC
Entity type:Organization
Organization Name:FAMILY & CHILDRENS SERVICE OF GR LYNN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAROLI
Authorized Official - Middle Name:
Authorized Official - Last Name:LICARDIE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:781-598-5517
Mailing Address - Street 1:111 NORTH COMMON STREET
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902
Mailing Address - Country:US
Mailing Address - Phone:781-598-5517
Mailing Address - Fax:781-581-6614
Practice Address - Street 1:111 N COMMON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-4223
Practice Address - Country:US
Practice Address - Phone:781-598-5517
Practice Address - Fax:781-581-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
66081OtherCIGNA INSURANCE
116228000OtherMAGELLAN BELL HEALTH
FA P10006Medicare ID - Type Unspecified