MEDICARE: DR. THOMAS J. LAVIN III PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	PS244	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3581-5	OTHER	RI	BLUE CROSS

General Provider Information

NPI Number	:	1013952043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS J. LAVIN III PH.D.

Provider Business Mailing Address
First Line	:	42 WESTWOOD AVE
Second Line	:
City	:	RUMFORD
State	:	RI
Zip	:	02916-1623
Country	:	US
Telephone Number	:	401-438-0468
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 WESTWOOD AVE
Second Line	:
City	:	RUMFORD
State	:	RI
Zip	:	02916-1623
Country	:	US
Telephone Number	:	401-438-0468
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2007

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