Provider Demographics
NPI:1689914608
Name:LAVOIE, TIMOTHY J (MHRT-CSP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:LAVOIE
Suffix:
Gender:M
Credentials:MHRT-CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WESLEYAN ST
Mailing Address - Street 2:
Mailing Address - City:FORT FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04742-2010
Mailing Address - Country:US
Mailing Address - Phone:207-473-9285
Mailing Address - Fax:207-473-9403
Practice Address - Street 1:8 WESLEYAN ST
Practice Address - Street 2:
Practice Address - City:FORT FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04742-2010
Practice Address - Country:US
Practice Address - Phone:207-473-9285
Practice Address - Fax:207-473-9403
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010276859Medicaid