MEDICARE: DR. ANTHONY MICHAEL TARESCAVAGE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	7458	OH
2	103TF0200X	Forensic Psychologist	7458	OH
3	103TC0700X	Clinical Psychologist	7458	OH

General Provider Information

NPI Number	:	1083245468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY MICHAEL TARESCAVAGE PHD

Provider Business Mailing Address
First Line	:	7828 W LIST LN
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44130-7129
Country	:	US
Telephone Number	:	440-547-8163
Fax Number	:

Provider Business Practice Location Address
First Line	:	16600 W SPRAGUE RD STE 260
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-6319
Country	:	US
Telephone Number	:	216-714-0092
Fax Number	:	216-714-0092

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2020
Last Update Date	:	01/22/2022

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