Provider Demographics
NPI:1043342611
Name:LAVELLA, LISA ANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:LAVELLA
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 1:8644 E WOODLEY WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-1082
Mailing Address - Country:US
Mailing Address - Phone:480-848-4411
Mailing Address - Fax:888-778-3569
Practice Address - Street 1:8644 E WOODLEY WAY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-1082
Practice Address - Country:US
Practice Address - Phone:480-848-4411
Practice Address - Fax:888-778-3569
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71007097103TC0700X
AZ4939103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical