Individual
DR. MICHAEL LAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2050A 2ND ST SE, KIRTLAND AFB, NM 87117-2765
(505) 846-3200
Mailing address
2050A 2ND ST SE, KIRTLAND AFB, NM 87117-5901
(505) 846-3200
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
001171
IA
103TC0700X
Clinical Psychologist
03750
MD
103TC0700X
Clinical Psychologist
0810002922
VA
103TC0700X
Clinical Psychologist
3422
AZ
103TC0700X
Clinical Psychologist
PSY 100094
DC
103TC0700X
Clinical Psychologist
Primary
PSY1645
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
292789
ANTHEM BC/BS
DC
01
—
7051521
AETNA
DC
01
—
F9950001
CAREFIRST BC/BS ALL PLANS
DC
Enumeration date
06/13/2005
Last updated
05/20/2022
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