Provider Demographics
NPI:1497979744
Name:LAVIN, SHARON (MFC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:LAVIN
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19634 VENTURA BLVD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2966
Mailing Address - Country:US
Mailing Address - Phone:818-708-3750
Mailing Address - Fax:818-708-3992
Practice Address - Street 1:19634 VENTURA BLVD STE 325
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2993
Practice Address - Country:US
Practice Address - Phone:818-708-3750
Practice Address - Fax:818-708-3992
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0000532168-0001-6106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 25638OtherLICENCE NUMBER