Healthcare Provider Details

I. General information

NPI: 1932169687
Provider Name (Legal Business Name): MARION S STAVIN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 GREENWOOD DR
BETHLEHEM PA
18017-3677
US

IV. Provider business mailing address

3961 LILAC RD
ALLENTOWN PA
18103-9745
US

V. Phone/Fax

Practice location:
  • Phone: 610-868-1577
  • Fax: 610-434-6486
Mailing address:
  • Phone: 610-434-2485
  • Fax: 610-434-6486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS007180-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: