Healthcare Provider Details

I. General information

NPI: 1992934954
Provider Name (Legal Business Name): ZIV BEN-DOV MFA, MS, NCC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 CLAY AVE
SCRANTON PA
18510-1129
US

IV. Provider business mailing address

841 CLAY AVE
SCRANTON PA
18510-1129
US

V. Phone/Fax

Practice location:
  • Phone: 570-498-6322
  • Fax: 570-347-1485
Mailing address:
  • Phone: 570-498-6322
  • Fax: 570-347-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC005186
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: