Provider Demographics
NPI:1306997812
Name:LAVY, CHRISTINA J
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:J
Last Name:LAVY
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 1:2680 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4215
Mailing Address - Country:US
Mailing Address - Phone:234-867-5001
Mailing Address - Fax:
Practice Address - Street 1:2680 W MARKET ST
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4215
Practice Address - Country:US
Practice Address - Phone:234-867-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE7496101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6289141OtherUBH
OH341213335CLOtherSUMMACARE