Provider Demographics
NPI:1952594806
Name:LAVELLE, SUZANNE MARIE (PSYD)
Entity Type:Individual
Prefix:MISS
First Name:SUZANNE
Middle Name:MARIE
Last Name:LAVELLE
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 1:625 COMMERCE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2733
Mailing Address - Country:US
Mailing Address - Phone:863-732-9300
Mailing Address - Fax:863-732-9303
Practice Address - Street 1:625 COMMERCE DR STE 104
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2733
Practice Address - Country:US
Practice Address - Phone:863-732-9300
Practice Address - Fax:863-732-9303
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical