Provider Demographics
NPI:1265196240
Name:LINHARES, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:LINHARES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 GLEN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-4431
Mailing Address - Country:US
Mailing Address - Phone:401-450-1228
Mailing Address - Fax:
Practice Address - Street 1:107 GLEN MEADOWS DR
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-4431
Practice Address - Country:US
Practice Address - Phone:401-450-1228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA513720103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool