Healthcare Provider Details

I. General information

NPI: 1598688079
Provider Name (Legal Business Name): NANCY L PAVELKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 WARREN AVE
SPRING LAKE NJ
07762-1233
US

IV. Provider business mailing address

611 MCCLELLAN ST
LONG BRANCH NJ
07740-5834
US

V. Phone/Fax

Practice location:
  • Phone: 732-816-5089
  • Fax:
Mailing address:
  • Phone: 732-816-5089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01234
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: