Provider Demographics
NPI:1962704767
Name:LAVIDOR, ERIN (LICSW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:LAVIDOR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585-597 MERRIMACK STREET
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3908
Mailing Address - Country:US
Mailing Address - Phone:978-937-9448
Mailing Address - Fax:978-970-0057
Practice Address - Street 1:17 WARREN STREET
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2216
Practice Address - Country:US
Practice Address - Phone:978-937-9448
Practice Address - Fax:978-970-2225
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1137401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical