Healthcare Provider Details

I. General information

NPI: 1184466559
Provider Name (Legal Business Name): ELLA JAY AMARAL LAVOIE MA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 BURNET AVE
CINCINNATI OH
45219-2426
US

IV. Provider business mailing address

715 W CHESTNUT ST APT 5
OXFORD OH
45056-2042
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-5801
  • Fax:
Mailing address:
  • Phone: 774-993-9680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: