Provider Demographics
NPI:1306277850
Name:LAVALLE, JOHN (PHD , LCSW)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:LAVALLE
Suffix:
Gender:M
Credentials:PHD , LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W 24TH ST
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1334
Mailing Address - Country:US
Mailing Address - Phone:212-255-0978
Mailing Address - Fax:
Practice Address - Street 1:430 W 24TH ST
Practice Address - Street 2:SUITE 1-B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1334
Practice Address - Country:US
Practice Address - Phone:212-255-0978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR033303-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical