Provider Demographics
NPI:1578611026
Name:SLOVAK, JANET MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:MARIE
Last Name:SLOVAK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 IMPERIAL DR
Mailing Address - Street 2:
Mailing Address - City:MOHNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19540-8834
Mailing Address - Country:US
Mailing Address - Phone:717-394-9077
Mailing Address - Fax:717-394-9078
Practice Address - Street 1:731 IMPERIAL DR
Practice Address - Street 2:
Practice Address - City:MOHNTON
Practice Address - State:PA
Practice Address - Zip Code:19540-8834
Practice Address - Country:US
Practice Address - Phone:717-394-9077
Practice Address - Fax:717-394-9078
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015161103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11919148OtherCAQH
PASL1389620OtherPENNSYLVANIA BLUESHIELD
PA01114901OtherCAPITAL BLUE CROSS
PA01874844Medicaid
PA01874844Medicaid