Provider Demographics
NPI:1821050774
Name:GAVIN, KATHLEEN M (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:GAVIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4949 LIBERTY LANE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9017
Mailing Address - Country:US
Mailing Address - Phone:610-841-4422
Mailing Address - Fax:610-821-1243
Practice Address - Street 1:4949 LIBERTY LANE
Practice Address - Street 2:SUITE 5
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9017
Practice Address - Country:US
Practice Address - Phone:610-841-4422
Practice Address - Fax:610-821-1243
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-006490-L1041C0700X
1041C0700X
PACW006490L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical