MEDICARE: DR. DANIELLE LAVELLE 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	103T00000X	Psychologist	4268	NJ

General Provider Information

NPI Number	:	1477632610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE LAVELLE PH.D.

Provider Business Mailing Address
First Line	:	12 VICTORIA CT
Second Line	:
City	:	CREAM RIDGE
State	:	NJ
Zip	:	08514-1527
Country	:	US
Telephone Number	:	732-796-3729
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 VICTORIA CT
Second Line	:
City	:	CREAM RIDGE
State	:	NJ
Zip	:	08514-1527
Country	:	US
Telephone Number	:	732-796-3729
Fax Number	:

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	03/01/2018

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