Provider Demographics
NPI:1619253838
Name:LITVIK, CARLY AGNES (MT-BC)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:AGNES
Last Name:LITVIK
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6018 SIERRAVALE WAY
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-3417
Mailing Address - Country:US
Mailing Address - Phone:916-905-0217
Mailing Address - Fax:
Practice Address - Street 1:6018 SIERRAVALE WAY
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-3417
Practice Address - Country:US
Practice Address - Phone:916-905-0217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist