Provider Demographics
NPI:1891544854
Name:CIVITARESE, KIMBERLY BETH
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BETH
Last Name:CIVITARESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565-1612
Mailing Address - Country:US
Mailing Address - Phone:724-433-4442
Mailing Address - Fax:
Practice Address - Street 1:313 W LIBERTY ST STE 224
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2791
Practice Address - Country:US
Practice Address - Phone:717-394-3994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional