Individual ProviderCicely C. TaravellaPsychologistBehavioral Health & Social Service ProvidersPractice Address1500 E Woodrow Wilson Ave, Trp/Mental Health (116a2), Jackson, MS 39216-5116(601) 362-4471PECOS EnrollmentBased on the most recent information from CMS, provider Cicely C. Taravella does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1376894212Provider TypeIndividualFull NameTaravella, Cicely C.CredentialPH.D.GenderFemaleSole ProprietorNoEnumeration Date10/1/2012Last Updated10/1/2012Contact InformationPractice LocationPractice Address1500 E Woodrow Wilson Ave, Trp/Mental Health (116a2), Jackson, MS 39216-5116Phone(601) 362-4471FaxUnlisted FaxMailing LocationMailing Address1500 E Woodrow Wilson Ave, Trp/Mental Health (116a2), Jackson, MS 39216-5116Phone(601) 362-4471FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode103TC0700XPrimaryDescriptionPsychologistBehavioral Health & Social Service ProvidersLicense52903Mississippi