Provider Demographics
NPI:1841502085
Name:KILLILEA, LYNDSEY M (LICSW)
Entity type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:M
Last Name:KILLILEA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CHELMSFORD ST
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2359
Mailing Address - Country:US
Mailing Address - Phone:978-256-1467
Mailing Address - Fax:
Practice Address - Street 1:201 CHELMSFORD ST
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2359
Practice Address - Country:US
Practice Address - Phone:978-256-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-03
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6998841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical