Healthcare Provider Details

I. General information

NPI: 1366118655
Provider Name (Legal Business Name): KYLE WILLIAM DEAVER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 SPRING ST # 5047
PRINCETON NJ
08542-6901
US

IV. Provider business mailing address

28 SPRING ST # 5047
PRINCETON NJ
08542-6901
US

V. Phone/Fax

Practice location:
  • Phone: 908-864-7148
  • Fax:
Mailing address:
  • Phone: 908-864-7148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC020223
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01021000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: