MEDICARE: SUSAN MARGARET PAVA LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	001658	NY

General Provider Information

NPI Number	:	1275110090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARGARET PAVA LMFT

Provider Business Mailing Address
First Line	:	55 N BROADWAY APT 2-12
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10601-1645
Country	:	US
Telephone Number	:	914-329-0987
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 N BROADWAY APT 2-12
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10601-1645
Country	:	US
Telephone Number	:	914-719-6604
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2021
Last Update Date	:	03/26/2021

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