MEDICARE: PHYLLIS LAVIGNA LCSW

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	1041C0700X	Clinical Social Worker	SW9461	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740547686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS LAVIGNA LCSW

Provider Business Mailing Address
First Line	:	1635 S RIDGEWOOD AVE STE 225
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-8478
Country	:	US
Telephone Number	:	386-788-5021
Fax Number	:	386-308-0002

Provider Business Practice Location Address
First Line	:	1635 S RIDGEWOOD AVE STE 225
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-8478
Country	:	US
Telephone Number	:	386-788-5021
Fax Number	:	386-788-5021

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

Provider Enumeration Date	:	04/17/2012
Last Update Date	:	06/04/2026

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Directions to “ PHYLLIS LAVIGNA LCSW” Practice Location

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