| Mark L. Tavitian, Ph.d., Ltd. | |
|
2730 S County Trl East Greenwich RI 02818-1730 | |
| (401) 884-9895 | |
| (401) 885-9898 |
| Full Name | Mark L. Tavitian, Ph.d., Ltd. |
|---|---|
| Speciality | Psychologist |
| Location | 2730 S County Trl, East Greenwich, Rhode Island |
| Authorized Official Name and Position | Mark L. Tavitian (PRESIDENT) |
| Authorized Official Contact | 4018849895 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark L. Tavitian, Ph.d., Ltd. 2730 S County Trl East Greenwich RI 02818-1730 Ph: (401) 884-9895 | Mark L. Tavitian, Ph.d., Ltd. 2730 S County Trl East Greenwich RI 02818-1730 Ph: (401) 884-9895 |
| NPI Number | 1316204910 |
|---|---|
| Provider Enumeration Date | 04/19/2012 |
| Last Update Date | 04/19/2012 |
| Medicare PECOS PAC ID | 8628232238 |
|---|---|
| Medicare Enrollment ID | O20120612000207 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316204910 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PS358 (Rhode Island) | Primary |
| Provider Name | Mark L Tavitian |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609909399 PECOS PAC ID: 5799949301 Enrollment ID: I20120612000236 |
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