Provider Demographics
NPI:1194746206
Name:CIVALE, LAWRENCE J (LICSW)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:CIVALE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 HANSON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3603
Mailing Address - Country:US
Mailing Address - Phone:617-947-3261
Mailing Address - Fax:617-451-0803
Practice Address - Street 1:110 W SQUANTUM ST
Practice Address - Street 2:SUITE 21
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2122
Practice Address - Country:US
Practice Address - Phone:617-947-3261
Practice Address - Fax:617-451-0803
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW 110606-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical