Provider Demographics
NPI:1114955200
Name:TAVARES, LINDA (LMHC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:TAVARES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:528 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 HOPE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2532
Practice Address - Country:US
Practice Address - Phone:401-276-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00246101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI29655-9OtherBLUE CROSS
RI412685OtherBLUE CHIP
RI1104847946OtherTHE PROVIDENCE CENTER NPI
RI62-81698OtherUNITED BEHAVIORAL HEALTH
RILB56517Medicaid