Provider Demographics
NPI:1275110090
Name:PAVA, SUSAN MARGARET (LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARGARET
Last Name:PAVA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 N BROADWAY APT 2-12
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1645
Mailing Address - Country:US
Mailing Address - Phone:914-329-0987
Mailing Address - Fax:
Practice Address - Street 1:55 N BROADWAY APT 2-12
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1645
Practice Address - Country:US
Practice Address - Phone:914-719-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health