Provider Demographics
NPI:1790495331
Name:SIVILLI, TERESA (MPH, MSW)
Entity Type:Individual
Prefix:MISS
First Name:TERESA
Middle Name:
Last Name:SIVILLI
Suffix:
Gender:F
Credentials:MPH, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29004
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30359-0004
Mailing Address - Country:US
Mailing Address - Phone:678-551-2530
Mailing Address - Fax:
Practice Address - Street 1:1036 OXFORD ROAD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-2606
Practice Address - Country:US
Practice Address - Phone:678-551-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0087541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical