Provider Demographics
NPI:1538263116
Name:TAVEL, ANNE R (PHD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:R
Last Name:TAVEL
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 1:148 LINDEN STREET, SUITE 108
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7920
Mailing Address - Country:US
Mailing Address - Phone:781-235-7420
Mailing Address - Fax:781-235-7420
Practice Address - Street 1:148 LINDEN STREET, SUITE 108
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7920
Practice Address - Country:US
Practice Address - Phone:781-235-7420
Practice Address - Fax:781-235-7420
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1083103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW01732OtherBCBS
717705OtherTUFTS HEALTH PLAN
717705OtherTUFTS HEALTH PLAN
MAW01732Medicare ID - Type Unspecified