| Entity Name: | LAVIN PSYCHOLOGY SERVICES, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Feb 2022 (3 years ago) |
| Document Number: | L22000064332 |
| FEI/EIN Number | 82-2610589 |
| Address: | 3333 CLARK RD, 110, SARASOTA, FL, 34231 |
| Mail Address: | 3333 CLARK RD, 110, SARASOTA, FL, 34231, US |
| ZIP code: | 34231 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568971646 | 2017-09-21 | 2023-10-04 | 3333 CLARK RD STE 110, SARASOTA, FL, 342318437, US | 3333 CLARK RD STE 110, SARASOTA, FL, 342318437, US | |||||||||||||||||||||||||||||||
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| Phone | +1 858-859-0822 |
| Fax | 9419247546 |
Authorized person
| Name | MELISSA LAVIN |
| Role | CLINICAL PSYCHOLOGIST |
| Phone | 6035458355 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | 1359 |
| State | NH |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE OF FL DEPT. OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE |
| Number | 10924 |
| State | FL |
| Issuer | NH LICENSE BOARD FOR PSYCHOLOGIST |
| Number | 1359 |
| State | NH |
| Name | Role | Address |
|---|---|---|
| LAVIN MELISSA JDR | Agent | 3333 CLARK RD, SARASOTA, FL, 34231 |
| Name | Role | Address |
|---|---|---|
| LAVIN MELISSA J | Director | 3333 CLARK RD, SARASOTA, FL, 34231 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-01-05 | 3333 CLARK RD, 110, SARASOTA, FL 34231 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-05 | 3333 CLARK RD, 110, SARASOTA, FL 34231 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-05 |
| ANNUAL REPORT | 2023-01-17 |
| Florida Limited Liability | 2022-02-07 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
