Provider Demographics
NPI:1659612851
Name:LAVENSON, JOEL (MA, NCC, LCPC, LPC)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:
Last Name:LAVENSON
Suffix:
Gender:M
Credentials:MA, NCC, LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SAHAGIAN RD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:ME
Mailing Address - Zip Code:04917-4414
Mailing Address - Country:US
Mailing Address - Phone:207-689-8004
Mailing Address - Fax:207-465-2822
Practice Address - Street 1:109 SAHAGIAN RD
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:ME
Practice Address - Zip Code:04917-4414
Practice Address - Country:US
Practice Address - Phone:207-689-8004
Practice Address - Fax:207-465-2822
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3367101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health