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General NPI Number Information
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NPI Number | 1073753257
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Entity Type | Organization
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Legal Business Name | PATHWAY PRACTICE, INC.
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Dates
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Enumeration Date | 02/27/2009
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Last Update Date | 02/27/2009
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Provider Practice Location Address
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Address Line | 201 HOSPITAL DR
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City | DOVER
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State | OH
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Zip | 44622-2058
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Country | US
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Telephone | 330-343-6631
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Fax | 330-343-8188
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Provider Business Mailing Address
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Address Line | PO BOX 7
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City | DOVER
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State | OH
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Zip | 44622-0007
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Country | US
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Telephone | 330-343-6631
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Fax | 330-343-8188
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Authorized Official
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Title or Position | CEO
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Name | DR. JOSEPH J GAVIN
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Credential | PH.D.
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Telephone | 330-343-6631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E0001959SUPV
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1957
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S0017766
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C0007674
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License Number State | OH
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