Provider Demographics
NPI:1851269757
Name:LAVIGNE, SUZANNA
Entity type:Individual
Prefix:
First Name:SUZANNA
Middle Name:
Last Name:LAVIGNE
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 1:1 LAKESHORE BLVD S
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLE
Mailing Address - State:VT
Mailing Address - Zip Code:05458-2408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 LAKESHORE BLVD S
Practice Address - Street 2:
Practice Address - City:GRAND ISLE
Practice Address - State:VT
Practice Address - Zip Code:05458-2408
Practice Address - Country:US
Practice Address - Phone:802-585-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0134870101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health