Ronald John Gavlick, MA

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PS-007995-L Issued in PA

Practice address

750 E Broad St
Hazleton, PA 18201-6835

Phone

(570) 455-6385

NPI assigned

Jul 18, 2017

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 21, 2022.

{
    "created_epoch": "1500336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1780107177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 E BROAD ST",
            "city": "HAZLETON",
            "state": "PA",
            "postal_code": "182016835",
            "telephone_number": "570-455-6385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E BROAD ST",
            "city": "HAZLETON",
            "state": "PA",
            "postal_code": "182016835",
            "telephone_number": "570-455-6385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAVLICK",
        "first_name": "RONALD",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "PA",
            "license": "PS-007995-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Gambino
• Harsh Gandhi, MD
• Raveena Gandhi, DO
• Susan Joann Garrett, RN, BSN
• Daniel Gavio, DC
• Francisco A Gazek, MD
• Geisinger Medical Center
• Stephan R Glicken, MD
• Janet Ann Golaszewski, DMD M ED
• Diego De Jesus Gonzalez, MD

• All providers in Hazleton, PA
• Clinical Child & Adolescent Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.