Provider Demographics
NPI:1285652263
Name:LAVIN, PATRICK FRANCIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:FRANCIS
Last Name:LAVIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 VALLEY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-3917
Mailing Address - Country:US
Mailing Address - Phone:423-877-7232
Mailing Address - Fax:
Practice Address - Street 1:325 MARKET ST
Practice Address - Street 2:SUITE 303
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-1226
Practice Address - Country:US
Practice Address - Phone:423-778-9451
Practice Address - Fax:423-778-9453
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP 544103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3680768Medicaid
3680768Medicare UPIN
GA3680768Medicaid