Provider Demographics
NPI:1871218057
Name:LAVINO, JAMES (LPC, MT-BC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:LAVINO
Suffix:
Gender:
Credentials:LPC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1216
Mailing Address - Country:US
Mailing Address - Phone:267-736-8068
Mailing Address - Fax:
Practice Address - Street 1:1518 WALNUT ST STE 1502
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3408
Practice Address - Country:US
Practice Address - Phone:215-326-9173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17450225A00000X
PAPC018375101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist