Provider Demographics
NPI:1144510835
Name:LAVA, STEFANIE B (PSYD)
Entity type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:B
Last Name:LAVA
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 1:110 ROBIN RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-3711
Mailing Address - Country:US
Mailing Address - Phone:973-768-0856
Mailing Address - Fax:866-868-3006
Practice Address - Street 1:1082 DAVOL ST STE 201
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1124
Practice Address - Country:US
Practice Address - Phone:973-768-0856
Practice Address - Fax:866-868-3006
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9346103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical