Provider Demographics
NPI:1811374291
Name:PAVLICK, DAVID (MSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PAVLICK
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 TORRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-2725
Mailing Address - Country:US
Mailing Address - Phone:860-567-0852
Mailing Address - Fax:860-567-2417
Practice Address - Street 1:286 TORRINGTON RD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-2725
Practice Address - Country:US
Practice Address - Phone:860-567-0852
Practice Address - Fax:860-567-2417
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT39011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical