Provider Demographics
NPI:1972700839
Name:CIARAVINO, JAMES G (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:CIARAVINO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CORONADO ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-1713
Mailing Address - Country:US
Mailing Address - Phone:631-581-2314
Mailing Address - Fax:631-581-2314
Practice Address - Street 1:555 ISLIP AVE
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-1501
Practice Address - Country:US
Practice Address - Phone:516-521-0150
Practice Address - Fax:631-581-2314
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011062103TB0200X, 103TF0000X, 103TM1800X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool