Provider Demographics
NPI:1437855764
Name:COVONE, MICHAEL RUEBEN (PHD, MPH, MSW)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RUEBEN
Last Name:COVONE
Suffix:
Gender:M
Credentials:PHD, MPH, MSW
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:RUBEN
Other - Last Name:COVONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, MPH, MSW
Mailing Address - Street 1:4951 BUSINESS PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7174
Mailing Address - Country:US
Mailing Address - Phone:907-743-7200
Mailing Address - Fax:
Practice Address - Street 1:4951 BUSINESS PARK BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7174
Practice Address - Country:US
Practice Address - Phone:907-743-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK201338103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK201338OtherPSYCHOLOGIST