Basic Information
| Provider Information | |||||||||
| NPI: | 1629138243 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEAVINS | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 351 SILVER ST DUTTON HOME | ||||||||
| Address2: | RIVER VALLEY SERVICES | ||||||||
| City: | MIDDLETOWN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602625358 | ||||||||
| FaxNumber: | 8602625356 | ||||||||
| Practice Location | |||||||||
| Address1: | SILVER ST DUTTON HOME | ||||||||
| Address2: | RIVER VALLEY SERVICES | ||||||||
| City: | MIDDLETOWN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602625358 | ||||||||
| FaxNumber: | 8602625356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 002633 | CT | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.