Provider Demographics
NPI:1487894325
Name:PTASZEK, TINA LEE (MHC00384)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:LEE
Last Name:PTASZEK
Suffix:
Gender:F
Credentials:MHC00384
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DOIRE RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-3820
Mailing Address - Country:US
Mailing Address - Phone:401-464-2021
Mailing Address - Fax:
Practice Address - Street 1:24 DOIRE RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-3820
Practice Address - Country:US
Practice Address - Phone:401-464-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00384101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134Medicaid