Provider Demographics
NPI:1225329923
Name:LAVIN, AMY (MS)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:LAVIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:SLEETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1440 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1236
Mailing Address - Country:US
Mailing Address - Phone:610-644-6464
Mailing Address - Fax:610-644-4066
Practice Address - Street 1:1107 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-3143
Practice Address - Country:US
Practice Address - Phone:610-644-6464
Practice Address - Fax:215-412-5348
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)