Individual
LOREN N LAVIOLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
EDD
Contact information
Practice address
255 SOUTH 17TH STREET, SUITE 1605 MEDICAL TOWER BUILDING, PHILADELPHIA, PA 19103
(215) 545-5493
(215) 545-5494
Mailing address
255 SOUTH 17TH STREET, SUITE 1605 MEDICAL TOWER BUILDING, PHILADELPHIA, PA 19103
(215) 545-5493
(215) 545-5494
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS003802L
PA
Other
Enumeration date
05/24/2007
Last updated
07/08/2007
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