Doctor Name: | TRACEY PIVARNIK |
NPI Number: | 1194109421 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LPC, NCC |
License Number: | PC007667 |
Business Practice Address: | 37 Myrick St Edwardsville, PA - 187041734 |
Business Phone Number: | 5702626404 |
Business Fax Number: | |
Mailing Address: | 37 Myrick St, EDWARDSVILLE |
State: | PA |
Postal Code: | 187041734 |
Phone Number: | 5702626404 |
Fax Number: | |
NPI Enumeration Date: | 07/16/2015 |
NPI Last Update Date: | 11/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | PC007667 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |