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NPI Code Detail

MEDICARE: LYNETTE LAVERTY

MEDICARE: LYNETTE LAVERTY
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
1103TS0200XSchool PsychologistNY

General Provider Information

NPI Number : 1629928114
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNETTE LAVERTY
Provider Business Mailing Address
First Line : 19 ROBINSON RD
Second Line :
City : CLINTON
State : NY
Zip : 13323-1418
Country : US
Telephone Number : 315-853-6090
Fax Number :
Provider Business Practice Location Address
First Line : 19 ROBINSON RD
Second Line :
City : CLINTON
State : NY
Zip : 13323-1418
Country : US
Telephone Number : 315-853-6090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2026
Last Update Date : 02/02/2026

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Directions to “ LYNETTE LAVERTY ” Practice Location

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