Provider Demographics
NPI:1164565842
Name:JAVNA, CAROL (PHD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:JAVNA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 COUNTRY SIDE LN
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7941
Mailing Address - Country:US
Mailing Address - Phone:724-934-4726
Mailing Address - Fax:
Practice Address - Street 1:6200 BROOKTREE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9299
Practice Address - Country:US
Practice Address - Phone:724-934-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2009-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003720L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01479796Medicaid