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NPI Code Detail

MEDICARE: LAVIN PSYCHOLOGY SERVICES

MEDICARE: LAVIN PSYCHOLOGY SERVICES
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
1103TC0700XClinical Psychologist1359NH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110924OTHERFLSTATE OF FL DEPT. OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE
21359OTHERNHNH LICENSE BOARD FOR PSYCHOLOGIST

General Provider Information

NPI Number : 1568971646
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAVIN PSYCHOLOGY SERVICES
Provider Business Mailing Address
First Line : 3333 CLARK RD STE 110
Second Line :
City : SARASOTA
State : FL
Zip : 34231-8437
Country : US
Telephone Number : 858-859-0822
Fax Number : 941-924-7546
Provider Business Practice Location Address
First Line : 3333 CLARK RD STE 110
Second Line :
City : SARASOTA
State : FL
Zip : 34231-8437
Country : US
Telephone Number : 858-859-0822
Fax Number : 941-924-7546
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST
Name : MELISSA LAVIN
Credential : PSYD
Telephone Number : 603-545-8355
Provider Enumeration Date : 09/21/2017
Last Update Date : 10/04/2023

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Directions to “LAVIN PSYCHOLOGY SERVICES ” Practice Location

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