Provider Demographics
NPI:1174687727
Name:PAVLIK, DONNA (LCSW)
Entity Type:Individual
Prefix:PROF
First Name:DONNA
Middle Name:
Last Name:PAVLIK
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 1:7 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-1011
Mailing Address - Country:US
Mailing Address - Phone:732-991-6303
Mailing Address - Fax:
Practice Address - Street 1:81 ERNSTON RD
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-1765
Practice Address - Country:US
Practice Address - Phone:732-991-6303
Practice Address - Fax:732-316-0440
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052154001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical