| Name: | MARK L. TAVITIAN, Ph.D., LTD. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 06 Nov 1991 (33 years ago) |
| Identification Number: | 000066082 |
| ZIP code: | 02818 |
| County: | Kent County |
| Principal Address: | 2843 SOUTH COUNTY TRAIL SUITE 111, EAST GREENWICH, RI, 02818, USA |
| Purpose: | TO ENGAGE IN THE PRACTICE OF PSYCHOTHERAPY AND OTHER RELATED MATTERS INCLUDING CONSULTATION AND EDUCATION |
| NAICS: | 621112 - Offices of Physicians, Mental Health Specialists |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316204910 | 2012-04-19 | 2012-04-19 | 2730 S COUNTY TRL, EAST GREENWICH, RI, 028181730, US | 2730 S COUNTY TRL, EAST GREENWICH, RI, 028181730, US | |||||||||||||||||||
|
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| Phone | +1 401-884-9895 |
| Fax | 4018859898 |
Authorized person
| Name | DR. MARK L. TAVITIAN |
| Role | PRESIDENT |
| Phone | 4018849895 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PS358 |
| State | RI |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GREGORY P. MASSAD | Agent | 1050 MAIN STREET SUITE 8, EAST GREENWICH, RI, 02818, USA |
| Name | Role | Address |
|---|---|---|
| MARK L. TAVITIAN | TREASURER | 23 FOX RUN CRANSTON, RI 02921 USA |
| Name | Role | Address |
|---|---|---|
| BARBARA A. VARGAS | SECRETARY | 27 WILLIAMS STREET CRANSTON, RI 02916 USA |
| Name | Role | Address |
|---|---|---|
| MARK L TAVITIAN | PRESIDENT | 23 FOX RUN CRANSTON, RI 02921 USA |
| Name | Role | Address |
|---|---|---|
| SANDRA K. TAVITIAN | VICE PRESIDENT | 23 FOX RUN CRANSTON, RI 02921 USA |
| Name | Role | Address |
|---|---|---|
| MARK L. TAVITIAN | DIRECTOR | 23 FOX RUN CRANSTON, RI 02921 USA |
| Number | Name | File Date |
|---|---|---|
| 202451334310 | Annual Report - Amended | 2024-04-17 |
| 202451091880 | Annual Report | 2024-04-15 |
| 202334962300 | Annual Report | 2023-05-01 |
| 202217078320 | Annual Report | 2022-05-10 |
| 202193096820 | Annual Report | 2021-02-26 |
| 202035332790 | Annual Report | 2020-02-26 |
| 201987112470 | Annual Report | 2019-02-20 |
| 201858081900 | Annual Report | 2018-02-12 |
| 201747482810 | Statement of Change of Registered/Resident Agent | 2017-07-19 |
| 201737826310 | Annual Report | 2017-03-09 |
Date of last update: 07 Oct 2024
Sources: Rhode Island Department of State
