Provider Demographics
NPI:1144309212
Name:LAVER, ANITA T (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:T
Last Name:LAVER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:NITA
Other - Middle Name:T
Other - Last Name:LAVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:255 S 17TH ST
Mailing Address - Street 2:SUITE 2601
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19103
Mailing Address - Country:US
Mailing Address - Phone:215-763-9631
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST
Practice Address - Street 2:SUITE 2601
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19103
Practice Address - Country:US
Practice Address - Phone:215-763-9631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW012666103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
645185Medicare ID - Type Unspecified