Provider Demographics
NPI:1558452698
Name:LAVINE, EMILY SARA (LICSW)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:SARA
Last Name:LAVINE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 NASH RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-2723
Mailing Address - Country:US
Mailing Address - Phone:978-263-4732
Mailing Address - Fax:978-263-9778
Practice Address - Street 1:17 NASH RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-2723
Practice Address - Country:US
Practice Address - Phone:978-263-4732
Practice Address - Fax:978-263-9778
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10290661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical