Provider Demographics
NPI:1124048731
Name:STRUCKUS, LILLIAN R (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:R
Last Name:STRUCKUS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 OAK ST
Mailing Address - Street 2:APT. #25
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1372
Mailing Address - Country:US
Mailing Address - Phone:413-585-0620
Mailing Address - Fax:
Practice Address - Street 1:421 NORTH MAIN STREET
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:LEEDS
Practice Address - State:MA
Practice Address - Zip Code:01053-9764
Practice Address - Country:US
Practice Address - Phone:413-584-4040
Practice Address - Fax:413-582-3082
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1019291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical