Provider Demographics
NPI:1184772543
Name:LAVALLEE, MAUREEN MADELINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:MADELINE
Last Name:LAVALLEE
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 1:1010 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1237
Mailing Address - Country:US
Mailing Address - Phone:508-612-9344
Mailing Address - Fax:
Practice Address - Street 1:1010 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1237
Practice Address - Country:US
Practice Address - Phone:508-612-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1184772543OtherBC/BS
MA4564OtherLICENSE
MA1184772543Medicare NSC