Provider Demographics
NPI:1225705924
Name:LAVINE, SIMONE ALLEGRA (LPC)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:ALLEGRA
Last Name:LAVINE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 BELL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT EPHRAIM
Mailing Address - State:NJ
Mailing Address - Zip Code:08059-1711
Mailing Address - Country:US
Mailing Address - Phone:408-691-6669
Mailing Address - Fax:
Practice Address - Street 1:736 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106-1346
Practice Address - Country:US
Practice Address - Phone:856-202-6623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC01011000101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor