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General NPI Number Information
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NPI Number | 1972037752
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Entity Type | Individual
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Provider Name | DIANDRA KATHLEEN PAVLOSKY LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 707 ALEXANDER RD
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City | PRINCETON
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State | NJ
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Zip | 08540-6331
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Country | US
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Telephone | 908-334-5264
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Fax |
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Provider Business Mailing Address
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Address Line | 13202 DIAMOND CT
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City | WATCHUNG
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State | NJ
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Zip | 07069-6486
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Country | US
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Telephone | 908-334-5264
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC0571100
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License Number State | NJ
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