Provider Demographics
NPI:1821516584
Name:LAVALLE, DEVEN (MA)
Entity type:Individual
Prefix:MRS
First Name:DEVEN
Middle Name:
Last Name:LAVALLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:DEVEN
Other - Middle Name:
Other - Last Name:URESK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1413 STATE ROUTE 32
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1413 STATE ROUTE 32
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589
Practice Address - Country:US
Practice Address - Phone:845-294-8301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool