Provider Demographics
NPI:1548470123
Name:LILLIS, PATRICK JUDE (BFA, MA LMHC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JUDE
Last Name:LILLIS
Suffix:
Gender:M
Credentials:BFA, MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 NEWBURG ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2826
Mailing Address - Country:US
Mailing Address - Phone:617-327-4092
Mailing Address - Fax:
Practice Address - Street 1:129 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6497
Practice Address - Country:US
Practice Address - Phone:617-834-4235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6212101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health