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General NPI Number Information
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NPI Number | 1558452698
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Entity Type | Individual
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Provider Name | EMILY SARA LAVINE LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 17 NASH RD
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City | ACTON
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State | MA
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Zip | 01720-2723
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Country | US
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Telephone | 978-263-4732
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Fax | 978-263-9778
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Provider Business Mailing Address
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Address Line | 17 NASH RD
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City | ACTON
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State | MA
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Zip | 01720-2723
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Country | US
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Telephone | 978-263-4732
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Fax | 978-263-9778
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1029066
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License Number State | MA
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