Provider Demographics
NPI:1619997400
Name:GAVLICK, MARIELIA (PHD)
Entity Type:Individual
Prefix:MRS
First Name:MARIELIA
Middle Name:
Last Name:GAVLICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARIELIA
Other - Middle Name:
Other - Last Name:MASTROIANNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:95 MOUNT KEMBLE AVE
Mailing Address - Street 2:ATTN: C. LAMPRON
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5155
Mailing Address - Country:US
Mailing Address - Phone:973-971-4714
Mailing Address - Fax:973-290-7585
Practice Address - Street 1:95 MOUNT KEMBLE AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5155
Practice Address - Country:US
Practice Address - Phone:888-247-1400
Practice Address - Fax:973-290-7585
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist