Provider Demographics
NPI:1124231469
Name:PASKAVITZ, DARRELYN LEE (MSW LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DARRELYN
Middle Name:LEE
Last Name:PASKAVITZ
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WYNDHURST DR
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2715
Mailing Address - Country:US
Mailing Address - Phone:508-829-4945
Mailing Address - Fax:
Practice Address - Street 1:6 PLYMPTON ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1602
Practice Address - Country:US
Practice Address - Phone:508-829-0330
Practice Address - Fax:508-923-3462
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPAP23248Medicare ID - Type Unspecified