Basic Information
| Provider Information | |||||||||
| NPI: | 1003012394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAVIENA | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 E 28TH ST APT 4K | ||||||||
| Address2: | 4L | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100168538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122520396 | ||||||||
| FaxNumber: | 2126793015 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 E 28TH ST APT 4K | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100168538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122520396 | ||||||||
| FaxNumber: | 2126793015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TB0200X | 12787 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
No ID Information.