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:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 W WILLIAM CANNON DR # B-150430
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1473
Mailing Address - Country:US
Mailing Address - Phone:512-646-1072
Mailing Address - Fax:
Practice Address - Street 1:4301 W WILLIAM CANNON DR # B-150430
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1473
Practice Address - Country:US
Practice Address - Phone:512-646-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34252103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist