Provider Demographics
NPI:1326379660
Name:DELVALLE, LISA MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:DELVALLE
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 1:2721 WADEVIEW LOOP
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6533
Mailing Address - Country:US
Mailing Address - Phone:787-923-8072
Mailing Address - Fax:
Practice Address - Street 1:2721 WADEVIEW LOOP
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6533
Practice Address - Country:US
Practice Address - Phone:787-923-8072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3538103T00000X
FLPY11731103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist