Provider Demographics
NPI:1659474500
Name:LAVIOLA, MARISA ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:ANNE
Last Name:LAVIOLA
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 1:87 STILES RD. (SALEM PSYCHOLOGICAL ASSOCIATES)
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079
Mailing Address - Country:US
Mailing Address - Phone:603-893-7700
Mailing Address - Fax:603-893-7331
Practice Address - Street 1:87 STILES RD. (SALEM PSYCHOLOGICAL ASSOCIATES)
Practice Address - Street 2:SUITE 106
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079
Practice Address - Country:US
Practice Address - Phone:603-893-7700
Practice Address - Fax:603-893-7331
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH601103TC0700X
MA5073103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical