Provider Demographics
NPI:1013035963
Name:TAVELLA, FRANK PETER (CRC)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:PETER
Last Name:TAVELLA
Suffix:
Gender:M
Credentials:CRC
Other - Prefix:MR
Other - First Name:FRANCIS
Other - Middle Name:PETER
Other - Last Name:TAVELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:235 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4007
Mailing Address - Country:US
Mailing Address - Phone:516-799-1686
Mailing Address - Fax:
Practice Address - Street 1:91-01 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-523-4242
Practice Address - Fax:718-523-5520
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003168-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health