Provider Demographics
NPI:1790763431
Name:PAVLEK, MIRKO (LCSW-R)
Entity Type:Individual
Prefix:
First Name:MIRKO
Middle Name:
Last Name:PAVLEK
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 RAILROAD PL
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2124
Mailing Address - Country:US
Mailing Address - Phone:518-306-5126
Mailing Address - Fax:
Practice Address - Street 1:75 RAILROAD PL
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2124
Practice Address - Country:US
Practice Address - Phone:518-306-5126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0708081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05354AMedicare ID - Type Unspecified