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DR. ROGER J LAVINE PSYD.
Exercise & Sports >> Psychologist >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1336784875
Individual Registrant:DR. ROGER J LAVINE PSYD.
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
222 COMMERCIAL BLVD STE 200 LAUDERDALE BY THE SEA, FL 33308-4483 US
Tel: 954-716-6702 Fax: --
Tel: 954-716-6702 Fax: --
Contact information for business:
2808 NE 33RD CT APT 203 FORT LAUDERDALE, FL 33306-3014 US
Tel: 954-716-6702 Fax: --
Tel: 954-716-6702 Fax: --
Registration Information:
NPI: 1336784875
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 103TE1100X | Behavioral Health & Social Service Providers Psychologist Exercise & Sports | FL | PY10647 |
| N | 103TF0000X | Behavioral Health & Social Service Providers Psychologist | FL | PY10647 |
| N | 103TP2701X | Behavioral Health & Social Service Providers Psychologist | FL | PY10647 |
| Y | 103TC0700X | Behavioral Health & Social Service Providers Psychologist | FL | PY10647 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
