Provider Demographics
NPI:1639556061
Name:PAVLOVA-ROSENFELD, INNA (MSCP, NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:INNA
Middle Name:
Last Name:PAVLOVA-ROSENFELD
Suffix:
Gender:F
Credentials:MSCP, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 BUCK ROAD
Mailing Address - Street 2:SUITE H
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1561
Mailing Address - Country:US
Mailing Address - Phone:215-605-7313
Mailing Address - Fax:215-469-4044
Practice Address - Street 1:73 BUCK ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1561
Practice Address - Country:US
Practice Address - Phone:215-605-7313
Practice Address - Fax:215-469-4044
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007924101Y00000X, 101YP2500X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily