Provider Demographics
NPI:1194756684
Name:PELCOVITS, MARJORIE A (PHD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:A
Last Name:PELCOVITS
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 1:63 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3209
Mailing Address - Country:US
Mailing Address - Phone:401-323-6986
Mailing Address - Fax:401-331-6260
Practice Address - Street 1:295 GOVERNOR ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3241
Practice Address - Country:US
Practice Address - Phone:401-351-2111
Practice Address - Fax:401-331-6260
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS 291103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9259-1OtherBCBSRI PROVIDER NUMBER