Provider Demographics
NPI:1477623338
Name:PAVICH, DALE ANTHONY (MA, MSW)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:ANTHONY
Last Name:PAVICH
Suffix:
Gender:M
Credentials:MA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 CAMINO MANADERO
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-1063
Mailing Address - Country:US
Mailing Address - Phone:805-807-1717
Mailing Address - Fax:805-964-3954
Practice Address - Street 1:315 CAMINO MANADERO
Practice Address - Street 2:SUITE 258
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110
Practice Address - Country:US
Practice Address - Phone:805-681-5450
Practice Address - Fax:805-681-4747
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS71801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical