Healthcare Provider Details

I. General information

NPI: 1801811260
Provider Name (Legal Business Name): TINA MATARAZZO SHEFF LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA MATARAZZO

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W RIVER ST FL 3
PROVIDENCE RI
02904-2609
US

IV. Provider business mailing address

117 ELLENFIELD ST STE 101
PROVIDENCE RI
02905-4541
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-5700
  • Fax: 401-793-7801
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberISW01227
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: