Provider Demographics
NPI:1669017091
Name:DECAVALLAS, PARODA LOY (LMHC)
Entity Type:Individual
Prefix:
First Name:PARODA
Middle Name:LOY
Last Name:DECAVALLAS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 COMELY LN
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-5225
Mailing Address - Country:US
Mailing Address - Phone:518-598-3834
Mailing Address - Fax:
Practice Address - Street 1:19 COMELY LN
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-5225
Practice Address - Country:US
Practice Address - Phone:518-598-3834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006377-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006377-1OtherUNIVERSITY OF THE STATE OF NEW YORK EDUCATION DEPARTMENT OFFICE OF PROFESSIONS