Provider Demographics
NPI:1336691708
Name:CIVITELLI, JANET SCARBOROUGH (PHD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:SCARBOROUGH
Last Name:CIVITELLI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1401 LAVACA ST STE 40896
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1634
Mailing Address - Country:US
Mailing Address - Phone:512-348-8468
Mailing Address - Fax:512-265-9722
Practice Address - Street 1:1401 LAVACA ST STE 40896
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1634
Practice Address - Country:US
Practice Address - Phone:512-348-8468
Practice Address - Fax:512-265-9722
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34252103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist