Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PS244 | RI |
NPI | 1013952043 |
---|---|
Provider Name | Dr. Thomas J. Lavin Iii |
First Address | Rumford, RI 02916-1623 |
Second Address | Rumford, RI 02916-1623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3581-5 | BLUE CROSS (01) | RI |