Provider Demographics
NPI:1417429788
Name:JARVIS, TAMI RENE (CADC)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:RENE
Last Name:JARVIS
Suffix:
Gender:
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 KING PHILIP ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-5717
Mailing Address - Country:US
Mailing Address - Phone:401-481-7196
Mailing Address - Fax:
Practice Address - Street 1:183 BARTON ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-1932
Practice Address - Country:US
Practice Address - Phone:401-481-7196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00744101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)