Provider Demographics
NPI:1902225543
Name:LAVIGNE, ALISSA
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:LAVIGNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 S DIXIE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-1548
Mailing Address - Country:US
Mailing Address - Phone:561-612-6062
Mailing Address - Fax:561-612-6095
Practice Address - Street 1:3111 S DIXIE HWY STE 200
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-1548
Practice Address - Country:US
Practice Address - Phone:561-612-6045
Practice Address - Fax:561-612-6095
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010893100Medicaid