Provider Demographics
NPI:1578286910
Name:LAVIN, EMILY (LP-MFT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:LAVIN
Suffix:
Gender:F
Credentials:LP-MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W PLEASANT ST APT G5
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-1709
Mailing Address - Country:US
Mailing Address - Phone:862-219-8431
Mailing Address - Fax:
Practice Address - Street 1:6700 KIRKVILLE RD STE 103B
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9373
Practice Address - Country:US
Practice Address - Phone:315-492-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist