Roger J Lavine Jr., PSYD.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY10647 Issued in FL

Practice address

222 Commercial Blvd Ste 200
Lauderdale by the Sea, FL 33308-4483

Phone

(954) 716-6702

NPI assigned

Nov 7, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1573084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573084800000",
    "number": "1336784875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2808 NE 33RD CT APT 203",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333063014",
            "telephone_number": "954-716-6702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 COMMERCIAL BLVD STE 200",
            "city": "LAUDERDALE BY THE SEA",
            "state": "FL",
            "postal_code": "333084483",
            "telephone_number": "954-716-6702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAVINE",
        "first_name": "ROGER",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PSYD.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-07",
        "last_updated": "2019-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TE1100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Exercise & Sports",
            "state": "FL",
            "license": "PY10647",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "FL",
            "license": "PY10647",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "FL",
            "license": "PY10647",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY10647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenbeck LLC
• Brenda Klee, ARNP
• Natalie Koulouvaris, L.AC.
• Rhoda P Kublickis, MHS, CRDH, FAADH
• Julian Dieter Laumeier, PT
• Stephen Ronald Levin, PH.D.
• Carmen Maco, D.M.D
• Susan Marinelli, OTR
• Meridian Treatment Solutions, Inc
• Michael a. Abraham D.M.D., PA

• Clinical Psychologist in Lauderdale by the Sea, FL
• Providers in Lauderdale by the Sea, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.