Provider Demographics
NPI:1841790490
Name:TAVANI, MARIE ELENA (MA)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELENA
Last Name:TAVANI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 W 34TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3549
Mailing Address - Country:US
Mailing Address - Phone:814-838-1954
Mailing Address - Fax:
Practice Address - Street 1:1611 PEACH ST STE 185
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2125
Practice Address - Country:US
Practice Address - Phone:814-835-3132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health