Provider Demographics
NPI:1558001552
Name:MCGARVEY, KEVIN C
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:MCGARVEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3114
Mailing Address - Country:US
Mailing Address - Phone:484-213-9756
Mailing Address - Fax:
Practice Address - Street 1:2207 MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3114
Practice Address - Country:US
Practice Address - Phone:484-213-9756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
PAPC014335101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional