Provider Demographics
NPI:1396816906
Name:LAVIGNE, CINDY ANN
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:ANN
Last Name:LAVIGNE
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 1:320 ASH SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:NEWMARKET
Mailing Address - State:NH
Mailing Address - Zip Code:03857-2141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 LAFAYETTE RD
Practice Address - Street 2:SUITE C
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5679
Practice Address - Country:US
Practice Address - Phone:603-431-5600
Practice Address - Fax:603-431-5610
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0226225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME098827OtherANTHEM INDIV # MAINE
NH30414986Medicaid
NH1301235Y0NH02OtherANTHEM INDIV # NH
AA79032OtherHARVARD PILGRIM GROUP #
NHRE8968OtherMEDICARE GROUP
NH30414986Medicaid