Provider Demographics
NPI:1164970331
Name:TILL INC
Entity Type:Organization
Organization Name:TILL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR MONITOR
Authorized Official - Prefix:
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIEBER
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:781-302-4659
Mailing Address - Street 1:110 PARKVIEW DR APT 21
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-3967
Mailing Address - Country:US
Mailing Address - Phone:781-302-4659
Mailing Address - Fax:
Practice Address - Street 1:110 PARKVIEW DR APT 21
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-3967
Practice Address - Country:US
Practice Address - Phone:781-302-4659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health