Provider Demographics
NPI:1457905440
Name:GAVERN, SIMONA (MA ATR)
Entity Type:Individual
Prefix:
First Name:SIMONA
Middle Name:
Last Name:GAVERN
Suffix:
Gender:F
Credentials:MA ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-1726
Mailing Address - Country:US
Mailing Address - Phone:570-344-3048
Mailing Address - Fax:
Practice Address - Street 1:851 COMMERCE BLVD STE 107
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1762
Practice Address - Country:US
Practice Address - Phone:570-489-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-28
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty