Provider Demographics
NPI:1215265285
Name:LAURENT, LYVIA A
Entity type:Individual
Prefix:
First Name:LYVIA
Middle Name:A
Last Name:LAURENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CHRISTOPHER ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1218
Mailing Address - Country:US
Mailing Address - Phone:617-288-7450
Mailing Address - Fax:617-288-7457
Practice Address - Street 1:15 CHRISTOPHER ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1218
Practice Address - Country:US
Practice Address - Phone:617-288-7450
Practice Address - Fax:617-288-7457
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator