Provider Demographics
NPI:1518495258
Name:LAVELLE, OLIVIA HOLLY (MSW, PPSC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:HOLLY
Last Name:LAVELLE
Suffix:
Gender:F
Credentials:MSW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 HUGHES WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810-1877
Mailing Address - Country:US
Mailing Address - Phone:310-221-6336
Mailing Address - Fax:
Practice Address - Street 1:5201 GREAT AMERICA PKWY
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1122
Practice Address - Country:US
Practice Address - Phone:323-205-7088
Practice Address - Fax:866-280-0260
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86347101YM0800X
CA119670104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker