Provider Demographics
NPI:1093888653
Name:GAVARIS, ATHENA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ATHENA
Middle Name:
Last Name:GAVARIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905
Mailing Address - Country:US
Mailing Address - Phone:814-534-1095
Mailing Address - Fax:
Practice Address - Street 1:320 MAIN STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901
Practice Address - Country:US
Practice Address - Phone:814-534-1095
Practice Address - Fax:914-534-6145
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0154391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical