Provider Demographics
NPI:1154430015
Name:LAVIN, DIANNE S (PSYD, RN, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:S
Last Name:LAVIN
Suffix:
Gender:F
Credentials:PSYD, RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 NORTHAVEN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4226
Mailing Address - Country:US
Mailing Address - Phone:719-641-5094
Mailing Address - Fax:
Practice Address - Street 1:7703 FLOYD CURL DRIVE
Practice Address - Street 2:UNIVERSITY OF TEXAS HSC SCHOOL OF NURSING
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4226
Practice Address - Country:US
Practice Address - Phone:719-641-5094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
TX663244363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX852N11OtherBCBS TX
TXTXB133872Medicare PIN