| Lmwall, Licsw, Cadc-ii, Llc | |
|
120 Dunphy Drive Northampton MA 01062-9602 | |
| (413) 320-1751 | |
| (413) 327-9523 |
| Full Name | Lmwall, Licsw, Cadc-ii, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 120 Dunphy Drive, Northampton, Massachusetts |
| Authorized Official Name and Position | Lisa M Wall (OWNER) |
| Authorized Official Contact | 4133201751 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lmwall, Licsw, Cadc-ii, Llc 120 Dunphy Drive Florence MA 01062-9602 Ph: (413) 320-1751 | Lmwall, Licsw, Cadc-ii, Llc 120 Dunphy Drive Northampton MA 01062-9602 Ph: (413) 320-1751 |
| NPI Number | 1235754037 |
|---|---|
| Provider Enumeration Date | 06/08/2020 |
| Last Update Date | 10/05/2022 |
| Certification Date | 10/05/2022 |
| Medicare PECOS PAC ID | 3173949559 |
|---|---|
| Medicare Enrollment ID | O20200817000171 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235754037 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lisa M Wall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366758203 PECOS PAC ID: 4082030465 Enrollment ID: I20200817000286 |
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