Provider Demographics
NPI:1629421466
Name:LAVAGNINO, CAITLIN (RN, PMHNP)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:LAVAGNINO
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 W 155TH ST
Mailing Address - Street 2:3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-7805
Mailing Address - Country:US
Mailing Address - Phone:925-413-9881
Mailing Address - Fax:
Practice Address - Street 1:509 W 155TH ST
Practice Address - Street 2:3B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-7805
Practice Address - Country:US
Practice Address - Phone:925-413-9881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-17
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY705541163W00000X
NY402294363LP0808X
NYF-402294-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse