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625 Commerce Dr Ste 104 Lakeland FL 33813-2733 | |
| (863) 732-9300 | |
| (863) 732-9303 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 625 Commerce Dr Ste 104, Lakeland, Florida |
| Authorized Official Name and Position | Suzanne Lavelle (OWNER) |
| Authorized Official Contact | 8133851632 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
625 Commerce Dr Ste 104 Lakeland FL 33813-2733 Ph: (863) 732-9300 | 625 Commerce Dr Ste 104 Lakeland FL 33813-2733 Ph: (863) 732-9300 |
| NPI Number | 1568943777 |
|---|---|
| Provider Enumeration Date | 08/25/2018 |
| Last Update Date | 06/04/2022 |
| Certification Date | 06/04/2022 |
| Medicare PECOS PAC ID | 1254677800 |
|---|---|
| Medicare Enrollment ID | O20190118000366 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568943777 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY8288 (Florida) | Primary |
| Provider Name | Suzanne Marie Lavelle |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1952594806 PECOS PAC ID: 4587821640 Enrollment ID: I20120201000960 |
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