Provider Demographics
NPI:1861936437
Name:LAVIERI, GRETEL J
Entity type:Individual
Prefix:
First Name:GRETEL
Middle Name:J
Last Name:LAVIERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 DARROW DR
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1809
Mailing Address - Country:US
Mailing Address - Phone:609-433-6417
Mailing Address - Fax:
Practice Address - Street 1:107 DARROW DR
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1809
Practice Address - Country:US
Practice Address - Phone:609-433-6417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2017-03-09
Deactivation Date:2017-02-22
Deactivation Code:
Reactivation Date:2017-03-09
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051962001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical