Healthcare Provider Details

I. General information

NPI: 1013645951
Provider Name (Legal Business Name): TINAIANA SCHWENCK ALVES ANTUNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 STEWART LN
BEVERLY MA
01915-1112
US

IV. Provider business mailing address

12 STEWART LN
BEVERLY MA
01915-1112
US

V. Phone/Fax

Practice location:
  • Phone: 978-239-9483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: