Provider Demographics
NPI:1134239163
Name:PAVIOUR, ROBERT (LCSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:PAVIOUR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 SOUTH PANTOPS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911
Mailing Address - Country:US
Mailing Address - Phone:434-296-9740
Mailing Address - Fax:434-296-1195
Practice Address - Street 1:175 SOUTH PANTOPS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911
Practice Address - Country:US
Practice Address - Phone:434-296-9740
Practice Address - Fax:434-296-1195
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040017751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
4345840OtherAETNA
VA174639OtherANTHEM
82076OtherSENTARA SOUTHERN HEALTH
031514OtherVALUE OPTIONS