Provider Demographics
NPI:1336350081
Name:LAVIOLETTE, LOREN N (EDD)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:N
Last Name:LAVIOLETTE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SOUTH 17TH STREET
Mailing Address - Street 2:SUITE 1605 MEDICAL TOWER BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103
Mailing Address - Country:US
Mailing Address - Phone:215-545-5493
Mailing Address - Fax:215-545-5494
Practice Address - Street 1:255 SOUTH 17TH STREET
Practice Address - Street 2:SUITE 1605 MEDICAL TOWER BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103
Practice Address - Country:US
Practice Address - Phone:215-545-5493
Practice Address - Fax:215-545-5494
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003802L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist