Provider Demographics
NPI:1447934419
Name:LILLIS, MAUREEN BRIDGET (MPH, GC-C)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:BRIDGET
Last Name:LILLIS
Suffix:
Gender:F
Credentials:MPH, GC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 BISHOP DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2523
Mailing Address - Country:US
Mailing Address - Phone:203-985-9229
Mailing Address - Fax:
Practice Address - Street 1:547 BISHOP DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-2523
Practice Address - Country:US
Practice Address - Phone:203-985-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor