Provider Demographics
NPI:1184446734
Name:LAVINE, KERRY SOPHIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:SOPHIE
Last Name:LAVINE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 FORBES RD STE 207
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2720
Mailing Address - Country:US
Mailing Address - Phone:781-990-5310
Mailing Address - Fax:
Practice Address - Street 1:222 FORBES RD STE 207
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2720
Practice Address - Country:US
Practice Address - Phone:781-990-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178020536101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional