Provider Demographics
NPI:1477016277
Name:LAVELLE, LISA (LMHC, CASAC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:LAVELLE
Suffix:
Gender:F
Credentials:LMHC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12A ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1155
Mailing Address - Country:US
Mailing Address - Phone:516-660-9539
Mailing Address - Fax:
Practice Address - Street 1:88 SUNNYSIDE BLVD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1591
Practice Address - Country:US
Practice Address - Phone:516-660-9539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28171101YA0400X
NY008529-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)