Provider Demographics
NPI:1982711651
Name:OCCUPATIONAL CLINICAL PSYCHOLOGISTS
Entity Type:Organization
Organization Name:OCCUPATIONAL CLINICAL PSYCHOLOGISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-256-6440
Mailing Address - Street 1:400 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3606
Mailing Address - Country:US
Mailing Address - Phone:847-256-6440
Mailing Address - Fax:
Practice Address - Street 1:400 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-3606
Practice Address - Country:US
Practice Address - Phone:847-256-6440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty