| Doctor Name: | DR. PAUL THADDEUS POVINELLI |
| NPI Number: | 1639255524 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | NY8450 |
| Business Practice Address: | 45 Congress St Trumansburg, NY - 148869103 |
| Business Phone Number: | 6073875741 |
| Business Fax Number: | 6073875575 |
| Mailing Address: | 45 Congress St, TRUMANSBURG |
| State: | NY |
| Postal Code: | 148869103 |
| Phone Number: | 6073875741 |
| Fax Number: | 6073875575 |
| NPI Enumeration Date: | 10/31/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | NY8450 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |