Provider Demographics
NPI:1548414998
Name:THEVAR, MICHAEL M (LSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:THEVAR
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 BETHLEHEM PIKE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936
Mailing Address - Country:US
Mailing Address - Phone:215-997-2000
Mailing Address - Fax:
Practice Address - Street 1:6800 MARKET STREET, SUITE 2A
Practice Address - Street 2:SUITE 106
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082
Practice Address - Country:US
Practice Address - Phone:215-997-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA130030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health