MEDICARE: DR. ROBERT ALAN LAVINE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	0810001957	VA
2	103TC0700X	Clinical Psychologist	0810001957	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	127234	OTHER		VALUE OPTIONS
2	100246	OTHER	VA	ANTHEM BCBS

General Provider Information

NPI Number	:	1518078328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ALAN LAVINE PH.D.

Provider Business Mailing Address
First Line	:	1602 BELLE VIEW BLVD.
Second Line	:	# 3374
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307
Country	:	US
Telephone Number	:	571-508-8916
Fax Number	:	703-435-7422

Provider Business Practice Location Address
First Line	:	1602 BELLE VIEW BLVD.
Second Line	:	# 3374
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307
Country	:	US
Telephone Number	:	571-508-8916
Fax Number	:	703-435-7422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/18/2020

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Directions to “ DR. ROBERT ALAN LAVINE PH.D.” Practice Location

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