Provider Demographics
NPI:1306951728
Name:SIVERT, PAUL MICHAEL (LCPC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MICHAEL
Last Name:SIVERT
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10806 REISTERSTOWN RD
Mailing Address - Street 2:STE 1-B
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2700
Mailing Address - Country:US
Mailing Address - Phone:410-998-9132
Mailing Address - Fax:410-902-4678
Practice Address - Street 1:8600 FOUNDRY ST
Practice Address - Street 2:STE 214 BOX 2011
Practice Address - City:SAVAGE
Practice Address - State:MD
Practice Address - Zip Code:20763-9512
Practice Address - Country:US
Practice Address - Phone:301-362-2221
Practice Address - Fax:301-362-1013
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0127101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
141883OtherPVPB