Provider Demographics
NPI:1598950503
Name:LAL, VIBHA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VIBHA
Middle Name:
Last Name:LAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S BURROWES ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-3863
Mailing Address - Country:US
Mailing Address - Phone:814-861-1233
Mailing Address - Fax:814-235-4898
Practice Address - Street 1:119 S BURROWES ST
Practice Address - Street 2:SUITE 604
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-3863
Practice Address - Country:US
Practice Address - Phone:814-861-1233
Practice Address - Fax:814-235-4898
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009240L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist