Provider Demographics
NPI:1629138243
Name:NEAVINS, TARA MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:NEAVINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 351 SILVER ST DUTTON HOME
Mailing Address - Street 2:RIVER VALLEY SERVICES
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-262-5358
Mailing Address - Fax:860-262-5356
Practice Address - Street 1:SILVER ST DUTTON HOME
Practice Address - Street 2:RIVER VALLEY SERVICES
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-262-5358
Practice Address - Fax:860-262-5356
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002633103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist