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General NPI Number Information
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NPI Number | 1831193291
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Entity Type | Individual
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Provider Name | MICHAEL LAVIN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 05/20/2022
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Provider Practice Location Address
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Address Line | 2050A 2ND ST SE
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City | KIRTLAND AFB
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State | NM
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Zip | 87117-2765
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Country | US
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Telephone | 505-846-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 2050A 2ND ST SE
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City | KIRTLAND AFB
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State | NM
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Zip | 87117-5901
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Country | US
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Telephone | 505-846-3200
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 100094
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 03750
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3422
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 001171
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License Number State | IA
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810002922
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License Number State | VA
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Taxonomy #6
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY1645
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License Number State | NM
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