Provider Demographics
NPI:1760084347
Name:LAVOIE, NATHAN (BA)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:LAVOIE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MONTCALM AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2839
Mailing Address - Country:US
Mailing Address - Phone:207-956-1777
Mailing Address - Fax:
Practice Address - Street 1:99 TOPEKA ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2717
Practice Address - Country:US
Practice Address - Phone:617-442-1499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)