Provider Demographics
NPI:1568289353
Name:CALIXTE-CIVIL, PATRICIA (PHD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:CALIXTE-CIVIL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7253 GENNAKER DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5896
Mailing Address - Country:US
Mailing Address - Phone:732-737-1277
Mailing Address - Fax:
Practice Address - Street 1:205 S HOOVER BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3500
Practice Address - Country:US
Practice Address - Phone:813-303-2742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12390103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist