Provider Demographics
NPI:1568425502
Name:PLAVIN, MARC HENRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:HENRY
Last Name:PLAVIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3175 CUSTER DR
Mailing Address - Street 2:SUITE #200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4023
Mailing Address - Country:US
Mailing Address - Phone:859-273-1288
Mailing Address - Fax:859-273-1278
Practice Address - Street 1:3175 CUSTER DR
Practice Address - Street 2:SUITE #200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4023
Practice Address - Country:US
Practice Address - Phone:859-273-1288
Practice Address - Fax:859-273-1278
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY0648103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY89006480Medicaid
KY89006480Medicaid