Provider Demographics
NPI:1700997384
Name:PAVLOU, MARCIA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:M
Last Name:PAVLOU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 N GROVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302
Mailing Address - Country:US
Mailing Address - Phone:312-346-7733
Mailing Address - Fax:708-848-0152
Practice Address - Street 1:721 N GROVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302
Practice Address - Country:US
Practice Address - Phone:312-346-7733
Practice Address - Fax:708-848-0152
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
IL711959103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYOR185OtherEMPIRE BCBS
IL21608111OtherBCBS OF IL
212595Medicare ID - Type Unspecified