| 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 SpecialistsThis U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of psychiatry or psychoanalysis. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau
| 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 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 2587547207 | 2020-04-16 | 0165 | PPP | 2843 South County Trail Suite 111, East Greenwich, RI, 02818 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 08 Apr 2025
Sources: Rhode Island Department of State
