Provider Demographics
NPI:1215621545
Name:SOHO INTEGRATIVE PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:SOHO INTEGRATIVE PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVELLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:646-537-1713
Mailing Address - Street 1:433 CENTRAL AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3853
Mailing Address - Country:US
Mailing Address - Phone:917-566-8031
Mailing Address - Fax:
Practice Address - Street 1:177 PRINCE ST APT 401
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2935
Practice Address - Country:US
Practice Address - Phone:646-537-1713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty