MEDICARE: DR. THERESA LOUISE LAVOIE PH.D.

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	103TC0700X	Clinical Psychologist	8088	MA

General Provider Information

NPI Number	:	1063469047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA LOUISE LAVOIE PH.D.

Provider Business Mailing Address
First Line	:	190 MILL RD
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-5515
Country	:	US
Telephone Number	:	617-733-8845
Fax Number	:

Provider Business Practice Location Address
First Line	:	790 TURNPIKE ST
Second Line	:	SUITE 106
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-6144
Country	:	US
Telephone Number	:	978-683-6065
Fax Number	:

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/08/2007

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