Provider Demographics
NPI:1073875894
Name:LAVOIE, GISELE M
Entity Type:Individual
Prefix:
First Name:GISELE
Middle Name:M
Last Name:LAVOIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CEDAR RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1807
Mailing Address - Country:US
Mailing Address - Phone:860-904-3656
Mailing Address - Fax:860-652-8597
Practice Address - Street 1:384 MERROW RD STE P
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3970
Practice Address - Country:US
Practice Address - Phone:860-904-3656
Practice Address - Fax:860-652-8597
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000911101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional