Healthcare Provider Details

I. General information

NPI: 1861840720
Provider Name (Legal Business Name): GINALYN E BAVERO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 REITZ BLVD 6
LEWISBURG PA
17837-9220
US

IV. Provider business mailing address

260 REITZ BLVD. 6
LEWISBURG PA
17837
US

V. Phone/Fax

Practice location:
  • Phone: 570-523-0605
  • Fax: 570-523-0676
Mailing address:
  • Phone: 570-523-0605
  • Fax: 570-523-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC007996
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: