Provider Demographics
NPI:1285969576
Name:LAVALLEE, KERRY (LICSW)
Entity type:Individual
Prefix:MS
First Name:KERRY
Middle Name:
Last Name:LAVALLEE
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 1:55 MILL RD
Mailing Address - Street 2:
Mailing Address - City:BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01505-2012
Mailing Address - Country:US
Mailing Address - Phone:508-928-7555
Mailing Address - Fax:
Practice Address - Street 1:164 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01505-1928
Practice Address - Country:US
Practice Address - Phone:508-928-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1149631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical