| Doctor Name: | DR. REVA S. TANKLE |
| NPI Number: | 1609201672 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 3598 |
| Business Practice Address: | 55 Chapel St Ste 2 Newton, MA - 024581060 |
| Business Phone Number: | 6176589821 |
| Business Fax Number: | |
| Mailing Address: | 55 Chapel St Ste 2, NEWTON |
| State: | MA |
| Postal Code: | 024581060 |
| Phone Number: | 6176589821 |
| Fax Number: | |
| NPI Enumeration Date: | 09/10/2013 |
| NPI Last Update Date: | 09/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103G00000X |
| License Number: | 3598 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Clinical Neuropsychologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |