Provider Demographics
NPI:1992889935
Name:LAVELLE, NANCY L (PHD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:LAVELLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 WESTMORELAND AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218
Mailing Address - Country:US
Mailing Address - Phone:412-247-1306
Mailing Address - Fax:
Practice Address - Street 1:311 SOUTH CRAIG STREET
Practice Address - Street 2:CRAIG STREET COMMONS SUITE 2D
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-247-1306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006923L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALA074316Medicare ID - Type Unspecified