Provider Demographics
NPI:1851403000
Name:LAVIN, JAMES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:LAVIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3362
Mailing Address - Country:US
Mailing Address - Phone:708-642-3300
Mailing Address - Fax:708-246-1147
Practice Address - Street 1:72 S LA GRANGE RD
Practice Address - Street 2:SUITE #3
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2475
Practice Address - Country:US
Practice Address - Phone:708-642-3300
Practice Address - Fax:708-246-1147
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL190064OtherVALUE OPTIONS PROV.#
IL231022OtherCOMPSYCH PROV. #
IL1671179OtherBC/BS ID#
IL231022OtherCOMPSYCH PROV. #