Healthcare Provider Details

I. General information

NPI: 1932049046
Provider Name (Legal Business Name): ANDREW LAVENSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2590 PINER RD
SANTA ROSA CA
95401-4035
US

IV. Provider business mailing address

125 6TH ST
SANTA ROSA CA
95401-6218
US

V. Phone/Fax

Practice location:
  • Phone: 707-524-2848
  • Fax:
Mailing address:
  • Phone: 707-392-2460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: