Provider Demographics
NPI:1346123825
Name:LALLY, BRYAN (LSW)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:LALLY
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 JACKSON ST UNIT 507
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-2180
Mailing Address - Country:US
Mailing Address - Phone:978-844-4099
Mailing Address - Fax:
Practice Address - Street 1:101 JACKSON ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-459-8656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical