Provider Demographics
NPI:1003507054
Name:BY, LAVI
Entity Type:Individual
Prefix:
First Name:LAVI
Middle Name:
Last Name:BY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5431 BOARDWALK WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-9421
Mailing Address - Country:US
Mailing Address - Phone:209-683-6669
Mailing Address - Fax:
Practice Address - Street 1:5431 BOARDWALK WAY
Practice Address - Street 2:
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-9421
Practice Address - Country:US
Practice Address - Phone:209-683-6669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician