Provider Demographics
NPI:1801911391
Name:GAVIN, LAUREN LIVERMORE (MFT)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:LIVERMORE
Last Name:GAVIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:LIVERMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2872 VIA CARMEN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-1442
Mailing Address - Country:US
Mailing Address - Phone:408-371-9482
Mailing Address - Fax:
Practice Address - Street 1:840 GUADALUPE PKWY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-1714
Practice Address - Country:US
Practice Address - Phone:408-299-3166
Practice Address - Fax:408-971-2651
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 34528106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist