Healthcare Provider Details

I. General information

NPI: 1790220317
Provider Name (Legal Business Name): LILLIAN SLAVIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 ROCKLAND RD
WILMINGTON DE
19803-3648
US

IV. Provider business mailing address

PO BOX 191
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 302-651-4500
  • Fax:
Mailing address:
  • Phone: 302-651-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberB2-0010457
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: