Provider Demographics
NPI:1811140007
Name:LILLEY, CALLY MARY (PMHCNS-BC)
Entity type:Individual
Prefix:
First Name:CALLY
Middle Name:MARY
Last Name:LILLEY
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16 BLOSSOM ST
Mailing Address - Street 2:R101
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3104
Mailing Address - Country:US
Mailing Address - Phone:617-643-6409
Mailing Address - Fax:617-248-0070
Practice Address - Street 1:16 BLOSSOM ST
Practice Address - Street 2:R101
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3104
Practice Address - Country:US
Practice Address - Phone:617-643-6409
Practice Address - Fax:617-248-0070
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA274284364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult