Provider Demographics
NPI:1326221995
Name:LAVRIHA-SMITH, NANCY ANNE
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANNE
Last Name:LAVRIHA-SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CLARK GATES RD
Mailing Address - Street 2:
Mailing Address - City:MOODUS
Mailing Address - State:CT
Mailing Address - Zip Code:06469-1222
Mailing Address - Country:US
Mailing Address - Phone:860-873-3466
Mailing Address - Fax:
Practice Address - Street 1:103 CLARK GATES RD
Practice Address - Street 2:
Practice Address - City:MOODUS
Practice Address - State:CT
Practice Address - Zip Code:06469-1222
Practice Address - Country:US
Practice Address - Phone:860-873-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist