Provider Demographics
NPI:1558017053
Name:PAVSHAK, JOHN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PAVSHAK
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 RIDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-5238
Mailing Address - Country:US
Mailing Address - Phone:412-614-9209
Mailing Address - Fax:
Practice Address - Street 1:4608 PENN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1309
Practice Address - Country:US
Practice Address - Phone:412-621-4757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013635101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health