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NPI Code Detail

MEDICARE: MS. JANE GRIVAS M.ED. DIP.ED.LBS

MEDICARE: MS. JANE GRIVAS M.ED. DIP.ED.LBS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorBH002627PA

General Provider Information

NPI Number : 1285176818
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JANE GRIVAS M.ED. DIP.ED.LBS
Provider Business Mailing Address
First Line : 111 ELWYN RD
Second Line :
City : MEDIA
State : PA
Zip : 19063-4622
Country : US
Telephone Number : 610-891-7007
Fax Number : 610-891-2666
Provider Business Practice Location Address
First Line : 111 ELWYN RD
Second Line :
City : MEDIA
State : PA
Zip : 19063-4622
Country : US
Telephone Number : 610-891-7007
Fax Number : 610-891-2666
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2016
Last Update Date : 09/03/2021

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