Provider Demographics
NPI:1568971646
Name:LAVIN PSYCHOLOGY SERVICES
Entity Type:Organization
Organization Name:LAVIN PSYCHOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:603-545-8355
Mailing Address - Street 1:3333 CLARK RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8437
Mailing Address - Country:US
Mailing Address - Phone:858-859-0822
Mailing Address - Fax:941-924-7546
Practice Address - Street 1:3333 CLARK RD STE 110
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-8437
Practice Address - Country:US
Practice Address - Phone:858-859-0822
Practice Address - Fax:941-924-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1359103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10924OtherSTATE OF FL DEPT. OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE
NH1359OtherNH LICENSE BOARD FOR PSYCHOLOGIST