Individual
DR. ROGER J LAVINE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD.
Contact information
Practice address
222 COMMERCIAL BLVD STE 200, LAUDERDALE BY THE SEA, FL 33308-4483
(954) 716-6702
Mailing address
2808 NE 33RD CT APT 203, FORT LAUDERDALE, FL 33306-3014
(954) 716-6702
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY10647
FL
103TE1100X
Exercise & Sports Psychologist
PY10647
FL
103TF0000X
Family Psychologist
PY10647
FL
103TP2701X
Group Psychotherapy Psychologist
PY10647
FL
Other
Enumeration date
11/07/2019
Last updated
11/07/2019
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