Provider Demographics
NPI:1922382092
Name:LAVELLE, JANET ELLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:ELLEN
Last Name:LAVELLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-0650
Mailing Address - Fax:
Practice Address - Street 1:1345 MOTOR PKWY
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5208
Practice Address - Country:US
Practice Address - Phone:631-855-1200
Practice Address - Fax:631-630-6297
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071701104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker