Provider Demographics
NPI:1760536593
Name:LAVIN, BERNADETTE D (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:D
Last Name:LAVIN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 CLEARFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4707
Mailing Address - Country:US
Mailing Address - Phone:410-375-8985
Mailing Address - Fax:
Practice Address - Street 1:8415 BELLONA LN
Practice Address - Street 2:SUITE 107
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-2055
Practice Address - Country:US
Practice Address - Phone:410-375-8985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional