Provider Demographics
NPI:1942809249
Name:PAVLIN, MEKALA POPPY (LMSW)
Entity Type:Individual
Prefix:
First Name:MEKALA
Middle Name:POPPY
Last Name:PAVLIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W 96TH ST APT 23E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6269
Mailing Address - Country:US
Mailing Address - Phone:917-774-7612
Mailing Address - Fax:
Practice Address - Street 1:275 W 96TH ST APT 23E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6269
Practice Address - Country:US
Practice Address - Phone:917-774-7612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128508701104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker