Provider Demographics
NPI:1255897740
Name:PAVONE, CAROLYN (BA, CRS)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:PAVONE
Suffix:
Gender:F
Credentials:BA, CRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 KEYSTONE ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-5560
Mailing Address - Country:US
Mailing Address - Phone:484-635-7645
Mailing Address - Fax:
Practice Address - Street 1:826 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1174
Practice Address - Country:US
Practice Address - Phone:610-419-3101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor