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General NPI Number Information
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NPI Number | 1568828747
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Entity Type | Individual
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Provider Name | MICHAEL LAVETSKY
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Gender | Male
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 630 W DIVISION ST
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City | DOVER
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State | DE
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Zip | 19904-2760
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Country | US
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Telephone | 813-323-4663
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Fax |
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Provider Business Mailing Address
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Address Line | 35 STATE RD APT. E20
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City | MEDIA
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State | PA
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Zip | 19063-1581
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC-0000569
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License Number State | DE
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