Provider Demographics
NPI:1669014650
Name:LAVIN, MIGUEL DEJESUS
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:DEJESUS
Last Name:LAVIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5180 W ATLANTIC AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8103
Mailing Address - Country:US
Mailing Address - Phone:508-328-9147
Mailing Address - Fax:
Practice Address - Street 1:5180 W ATLANTIC AVE STE 112
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8103
Practice Address - Country:US
Practice Address - Phone:508-328-9147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician