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General NPI Number Information
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NPI Number | 1023409869
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Entity Type | Organization
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Legal Business Name | ELAINE TAVANI, MS, LMFT, LLC
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Dates
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Enumeration Date | 02/16/2015
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Last Update Date | 02/16/2015
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Provider Practice Location Address
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Address Line | 41C NEW LONDON TPKE
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City | GLASTONBURY
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State | CT
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Zip | 06033-4206
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Country | US
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Telephone | 860-916-0204
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Fax |
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Provider Business Mailing Address
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Address Line | 41C NEW LONDON TPKE
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City | GLASTONBURY
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State | CT
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Zip | 06033-4206
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Country | US
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Telephone | 860-916-0204
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | ELAINE RENEE TAVANI
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Credential | MS, LMFT
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Telephone | 860-916-0204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001521
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License Number State | CT
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