Provider Demographics
NPI:1174927040
Name:PIVOVARNIK, JENNIFER (MED, LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:PIVOVARNIK
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DEWALT DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1724
Mailing Address - Country:US
Mailing Address - Phone:717-364-5464
Mailing Address - Fax:
Practice Address - Street 1:1710 RITNER HWY STE 5
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-9301
Practice Address - Country:US
Practice Address - Phone:717-243-1326
Practice Address - Fax:717-243-0174
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007887101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor