Provider Demographics
NPI:1376081760
Name:GRETEL J LAVIERI, LCSW LLC
Entity Type:Organization
Organization Name:GRETEL J LAVIERI, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRETEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAVIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:609-433-6417
Mailing Address - Street 1:107 DARROW DR
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1809
Mailing Address - Country:US
Mailing Address - Phone:609-433-6417
Mailing Address - Fax:
Practice Address - Street 1:107 DARROW DR
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1809
Practice Address - Country:US
Practice Address - Phone:609-433-6417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05196200251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health