Provider Demographics
NPI:1417214164
Name:LAVIN, NICHOLAS LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:LAWRENCE
Last Name:LAVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:913 S COLLEGE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3061
Mailing Address - Country:US
Mailing Address - Phone:337-232-2833
Mailing Address - Fax:337-234-4038
Practice Address - Street 1:913 S COLLEGE RD STE 102
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3061
Practice Address - Country:US
Practice Address - Phone:337-232-2833
Practice Address - Fax:337-234-4038
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2019-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA2079092084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry