Provider Demographics
NPI:1912218124
Name:LAVIN, DAVID JONATHAN (MSSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JONATHAN
Last Name:LAVIN
Suffix:
Gender:M
Credentials:MSSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 WALNUT ST
Mailing Address - Street 2:OFFICE 32
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1155 WALNUT ST
Practice Address - Street 2:OFFICE 32
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1242
Practice Address - Country:US
Practice Address - Phone:781-252-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS300114621Medicare UPIN