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General NPI Number Information
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NPI Number | 1316204910
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Entity Type | Organization
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Legal Business Name | MARK L. TAVITIAN, PH.D., LTD.
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | 2730 S COUNTY TRL
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City | EAST GREENWICH
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State | RI
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Zip | 02818-1730
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Country | US
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Telephone | 401-884-9895
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Fax | 401-885-9898
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Provider Business Mailing Address
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Address Line | 2730 S COUNTY TRL
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City | EAST GREENWICH
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State | RI
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Zip | 02818-1730
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Country | US
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Telephone | 401-884-9895
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Fax | 401-885-9898
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK L. TAVITIAN
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Credential | PH.D.
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Telephone | 401-884-9895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS358
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License Number State | RI
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