Healthcare Provider Details

I. General information

NPI: 1871218057
Provider Name (Legal Business Name): JAMES LAVINO LPC, MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 04/06/2025
Certification Date: 04/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 WALNUT ST STE 1502
PHILADELPHIA PA
19102-3408
US

IV. Provider business mailing address

1424 FLAT ROCK RD
PENN VALLEY PA
19072-1216
US

V. Phone/Fax

Practice location:
  • Phone: 215-326-9173
  • Fax:
Mailing address:
  • Phone: 267-736-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number17450
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018375
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: