Active NPI
Tinatin Surguladze, DH.D.
- Psychologist
- Providence, RI
National Provider Identifier
1700289360
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS01795
- Practice address
- 205 Waterman St Suite 106
Providence, RI 02906 - Phone
- (857) 333-0533
- NPI assigned
- Sep 26, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Psychologist | 103T00000X | 11259 | MA | |
| Psychologist | 103T00000X | PS01795 | RI | Primary |
Addresses
Primary practice location
205 Waterman St Suite 106
Providence, RI 02906
Mailing address
3 Burgess Rd
Foster, RI 02825
Phone (857) 333-0533
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11259 | MA | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588118400000",
"number": "1700289360",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 BURGESS RD",
"city": "FOSTER",
"state": "RI",
"postal_code": "02825",
"telephone_number": "857-333-0533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 WATERMAN ST SUITE 106",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "02906",
"telephone_number": "857-333-0533"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURGULADZE",
"first_name": "TINATIN",
"name_prefix": "Ms.",
"credential": "DH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-26",
"last_updated": "2020-04-29",
"certification_date": "2020-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "11259",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "RI",
"license": "PS01795",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.