MEDICARE: DENISE LAVALLEE

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1861953655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE LAVALLEE

Provider Business Mailing Address
First Line	:	401 MAIN ST STE 15
Second Line	:
City	:	AMHERST
State	:	MA
Zip	:	01002-2353
Country	:	US
Telephone Number	:	413-461-7120
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 MAIN ST STE 15
Second Line	:
City	:	AMHERST
State	:	MA
Zip	:	01002-2353
Country	:	US
Telephone Number	:	413-461-7120
Fax Number	:

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

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	03/26/2019

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Directions to “ DENISE LAVALLEE ” Practice Location

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