Provider Demographics
NPI:1861840720
Name:BAVERO, GINALYN E (LPC)
Entity type:Individual
Prefix:MRS
First Name:GINALYN
Middle Name:E
Last Name:BAVERO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 REITZ BLVD.
Mailing Address - Street 2:6
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837
Mailing Address - Country:US
Mailing Address - Phone:570-523-0605
Mailing Address - Fax:570-523-0676
Practice Address - Street 1:260 REITZ BLVD
Practice Address - Street 2:6
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9220
Practice Address - Country:US
Practice Address - Phone:570-523-0605
Practice Address - Fax:570-523-0676
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007996101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional