MEDICARE: LOREN N LAVIOLETTE EDD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS003802L	PA

General Provider Information

NPI Number	:	1336350081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOREN N LAVIOLETTE EDD

Provider Business Mailing Address
First Line	:	255 SOUTH 17TH STREET
Second Line	:	SUITE 1605 MEDICAL TOWER BUILDING
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103
Country	:	US
Telephone Number	:	215-545-5493
Fax Number	:	215-545-5494

Provider Business Practice Location Address
First Line	:	255 SOUTH 17TH STREET
Second Line	:	SUITE 1605 MEDICAL TOWER BUILDING
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103
Country	:	US
Telephone Number	:	215-545-5493
Fax Number	:	215-545-5494

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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Directions to “ LOREN N LAVIOLETTE EDD” Practice Location

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