Provider Demographics
NPI:1528090354
Name:CIAVARELLA, JESSICA D (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:D
Last Name:CIAVARELLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 SHERIDAN ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-8802
Mailing Address - Country:US
Mailing Address - Phone:954-552-7510
Mailing Address - Fax:954-212-6100
Practice Address - Street 1:9000 SHERIDAN ST
Practice Address - Street 2:SUITE 121
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-8802
Practice Address - Country:US
Practice Address - Phone:954-552-7510
Practice Address - Fax:954-212-6100
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7107103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12378663OtherMULTIPLAN
FL161720383OtherHORIZON HEALTH
FL7670760OtherAETNA
FL75064OtherBLUE CROSS BLUE SHIELD
FL75064ZMedicare ID - Type UnspecifiedMEDICARE