Cicely C. Taravella, Ph.D.
Psychologist, Clinical in Jackson, MS. Individual provider (NPI-1).
NPI number1376894212
StatusActive
Last updated in NPPESOct 1, 2012
Details
- NPI
- 1376894212
- Entity type
- Individual (NPI-1)
- Name
- Cicely C. Taravella
- Credential
- Ph.D.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 1, 2012
- Last updated
- Oct 1, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | 52903 | MS | Yes |
Practice location
1500 E Woodrow Wilson AveTrp/Mental Health (116a2)
Jackson, MS 39216-5116
Phone 601-362-4471
Mailing address
1500 E Woodrow Wilson AveTrp/Mental Health (116a2)
Jackson, MS 39216-5116
Phone 601-362-4471
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