Provider Demographics
NPI:1861884991
Name:TAVERAS, MARINELLY
Entity type:Individual
Prefix:
First Name:MARINELLY
Middle Name:
Last Name:TAVERAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 DIANE LN
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606
Mailing Address - Country:US
Mailing Address - Phone:610-396-9900
Mailing Address - Fax:610-396-9901
Practice Address - Street 1:543 ELM ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3386
Practice Address - Country:US
Practice Address - Phone:610-396-9900
Practice Address - Fax:610-396-9901
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131997103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst