=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922804947
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOGAN AVENA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2025
-----------------------------------------------------
Last Update Date | 02/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 POWELL ST
-----------------------------------------------------
City | NORRISTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19401-3820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-277-8275
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27 VICTORIA LN
-----------------------------------------------------
City | OCEAN VIEW
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08230-1450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-437-4045
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PC018242
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------