Provider Demographics
NPI:1013059377
Name:TEOLI-LAVALLEE, CATHY (LPCMH, LCDP)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:TEOLI-LAVALLEE
Suffix:
Gender:F
Credentials:LPCMH, LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 WALLACE DR
Mailing Address - Street 2:TOP OF THE WEDGE
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-2036
Mailing Address - Country:US
Mailing Address - Phone:302-595-2380
Mailing Address - Fax:302-595-2382
Practice Address - Street 1:1400 PEOPLES PLZ
Practice Address - Street 2:SUITE 127
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5707
Practice Address - Country:US
Practice Address - Phone:302-595-2380
Practice Address - Fax:302-595-2382
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECD-0000009101YA0400X
DEPC-0000266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000022913Medicaid