Individual
HEATHER LAVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPC
Contact information
Practice address
455 PENNSYLVANIA AVE STE 250, FORT WASHINGTON, PA 19034-3400
(215) 653-0363
Mailing address
455 PENNSYLVANIA AVE STE 250, FORT WASHINGTON, PA 19034-3400
(215) 653-0363
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PC002120
PA
Other
Enumeration date
06/27/2022
Last updated
06/27/2022
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