Provider Demographics
NPI:1982041968
Name:LAVELLA, PAUL R JR (MA, LPC, LCADC, ACS)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:R
Last Name:LAVELLA
Suffix:JR
Gender:M
Credentials:MA, LPC, LCADC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 COLUMBIA TPKE STE 201
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2189
Mailing Address - Country:US
Mailing Address - Phone:732-407-2653
Mailing Address - Fax:
Practice Address - Street 1:205 RIDGEDALE AVE STE 200
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1349
Practice Address - Country:US
Practice Address - Phone:855-202-7939
Practice Address - Fax:732-231-5189
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00174800101YA0400X
NJ37PC00455600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)