Doctor Name: | KRISTINA LAVERY |
NPI Number: | 1154733483 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CAS, NCSP |
License Number: | 2540134 |
Business Practice Address: | 216 County Route 64 Mexico, NY - 131143229 |
Business Phone Number: | 3159630864 |
Business Fax Number: | |
Mailing Address: | 55 E Utica St, OSWEGO |
State: | NY |
Postal Code: | 131262721 |
Phone Number: | 3154023660 |
Fax Number: | |
NPI Enumeration Date: | 05/21/2014 |
NPI Last Update Date: | 05/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 2540134 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |