Provider Demographics
NPI:1952884447
Name:LAVIN, ELAINE (PSYD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:LAVIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 POLY PL RM 14-201
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7104
Mailing Address - Country:US
Mailing Address - Phone:718-526-1000
Mailing Address - Fax:
Practice Address - Street 1:17900 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1468
Practice Address - Country:US
Practice Address - Phone:718-526-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023505103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical