Provider Demographics
NPI:1134788128
Name:LAL, BHAVNA (PSYD)
Entity type:Individual
Prefix:DR
First Name:BHAVNA
Middle Name:
Last Name:LAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3741
Mailing Address - Country:US
Mailing Address - Phone:814-753-1144
Mailing Address - Fax:
Practice Address - Street 1:490 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3741
Practice Address - Country:US
Practice Address - Phone:814-769-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist