Doctor Name: | MR. FRANK PETER TAVELLA |
NPI Number: | 1013035963 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CRC |
License Number: | 003168-1 |
Business Practice Address: | 91-01 Merrick Blvd Jamaica, NY - 11432 |
Business Phone Number: | 7185234242 |
Business Fax Number: | 7185235520 |
Mailing Address: | 235 Hamilton Ave, MASSAPEQUA |
State: | NY |
Postal Code: | 117584007 |
Phone Number: | 5167991686 |
Fax Number: | |
NPI Enumeration Date: | 03/27/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 003168-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |